Manager, Payer Operations (Remote)

The Manager, Payer Operations serves as the strategic leader overseeing the complex ecosystem of 130+ unique payer data integrations that directly impact patient care and practice success. In this critical role, you'll transform raw healthcare data into actionable insights while leading cross-functional teams through sophisticated technical challenges and serving as the trusted escalation point for high-priority data issues. You'll collaborate closely with Product, Technology, and Payer Strategy teams to influence the future of our data operations, moving from reactive troubleshooting to predictive, automated monitoring systems while ensuring compliance with healthcare regulations and maintaining the data integrity that enables providers to deliver exceptional patient care. This position combines strategic thinking with hands-on problem-solving, requiring you to translate complex technical data challenges into business solutions that keep our healthcare partners running smoothly and focused on what matters most: caring for patients. Candidates should be comfortable working remotely/work from home anywhere within the US.

Primary Duties:

Operational Strategy & Oversight

• Establish and monitor performance metrics (KPIs) to measure the reliability, latency, and saturation of payer data feeds.
• Define and refine standard operating procedures (SOPs) for data issue triage, clinical ingestion troubleshooting, and Primary Source Verification (PSV) audits.
• Lead discovery efforts for long-term data operations and technical requirements to transition from reactive troubleshooting to proactive monitoring.

Cross-Functional Collaboration

• Serve as the primary point of escalation for high-priority payer data issues, coordinating closely with Payer Strategy & Engagement (PSE), Health Plan Partnerships (HPP), Product, and Technology teams.
• Partner with Product teams to identify systemic data ingestion failures and influence the product roadmap for automated monitoring solutions.
• Support the Care Gap operations team by overseeing investigations into manual upload failures and measure mapping exercises.

Compliance & Quality Assurance

• Oversee the documentation and submission processes for HEDIS and other clinical data extracts to ensure audit readiness.
• Ensure all team activities comply with healthcare regulations and data security standards.
• Other duties as assigned.

• Bachelor's degree in Healthcare Administration, Data Analytics, Information Systems, or a related field, or equivalent experience.
• 5+ years of experience in healthcare data operations, payer relations, or health informatics, with at least 2-4 years in a leadership or supervisory capacity.
• Advanced proficiency in SQL for data investigation and root cause analysis; familiarity with data observability tools (e.g. Tableau) and SFTP protocols.
• Deep understanding of payer data structures (claims, clinical feeds, care gaps) and healthcare quality reporting (HEDIS, MA Stars).
• Proven ability to lead teams through complex technical troubleshooting and manage high-volume issue queues (e.g., Jira-based workflows).
• Exceptional verbal and written communication skills, with a demonstrated ability to influence decision-makers and manage external payer relationships effectively.
• Ability to translate complex data issues into actionable business insights and operational improvements., * Master's degree in Healthcare Administration, Business Administration, Data Analytics, Information Systems, or a related field, or equivalent experience.
• Experience in value based care
• Experience promoting or selling to physicians, physician practices or related associations
• Experience leading cross-functionally within a complex organization
• Proactive self-starter with the ability to lead in a fast-paced environment, with the ability to work independently, as part of a team, and as a leader

At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission. In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members: Flexible work schedules and the ability to work remotely are available for many roles Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners Robust time-off plan (21 days of PTO in your first year) Two paid volunteer days and 11 paid holidays 12 weeks paid parental leave for all new parents Six weeks paid sabbatical after six years of service Educational Assistant Program and Clinical Employee Reimbursement Program 401(k) with up to 4% match Stock options And much more!

Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.