Manager, Payer Integrations
Skills
- Expert knowledge of payer operations, benefit design, funding structures, eligibility, and payment workflows
- Hands-on experience with HIPAA/EDI (837, 835, 270/271), clearinghouses, payer portals, roster/CAQH workflows, EFT/ERA
- Proven success managing end-to-end payer integration projects with measurable KPI improvements
- Strong data analysis and problem-solving skills to identify integration risks and mitigation strategies
- Excellent communication and stakeholder management across technical and non-technical audiences
- Experience building dashboards and using BI tools (e.g., Looker) and workflow tools (Asana, Jira)
- Familiarity with integration platforms (e.g., Apero or similar) and automation tooling
Responsibilities
- Own a portfolio of payer integrations to drive clean claims, faster payments, and accurate adjudication across systems.
- Define and achieve key metrics (clean-claim rate, denial reductions, DSO, launch timelines).
- Lead, hire, and develop a team of Payer Integration Managers, fostering accountability and growth.
- Prioritize and resource integrations and escalations based on business risk and revenue impact.
- Manage end-to-end payer launches including requirements, testing, EDI, portals, and workflow setup.
- Identify and resolve issues in claims logic, provider data, and system configuration to ensure seamless adjudication.
- Partner with Billing, Benefits, Legal, and other teams to create repeatable playbooks and system-wide solutions.
- Build and evolve a payer KPI dashboard to monitor performance and enable continuous improvement.
- Represent Spring Health with payer contacts to align implementation and operational processes.
- Drive automation, tooling, and process improvements to reduce manual work and accelerate cycle time.
- Lead special projects and translate learnings into scalable, evergreen practices.
Education
- Bachelor’s degree preferred (Health Information Management Systems or related field)
- Relevant certifications (e.g., Certified EDI Professional) are a plus
- Equivalent hands-on experience in payer integrations/RCM is accepted
Benefits
- Health, dental, and vision starting day one; HSA/FSA options with employer HSA contribution
- Employer 401(k) match up to 2%
- Access to Spring Health network visits for employees and dependents
- Competitive paid time off, sick leave, and company holidays
- Parental leave (up to 18 weeks birthing, 16 weeks non-birthing) after 6 months
- Access to Noom, fertility support (Carrot) with up to $4,000 reimbursement
- Wellhub fitness/mindfulness subscription and BrightHorizons care benefits
- Up to $1,000 annual professional development reimbursement
- $200/year donation matching
- Stock options and comprehensive total rewards package
Average salary estimate
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