Manager, Payer Contracting

About Open Loop

Open Loop was co-founded by CEO, Dr. Jon Lensing, and COO, Christian Williams, with the vision to bring care anywhere. Our telehealth support solutions are thoughtfully designed to streamline and simplify go-to-market care delivery for companies offering meaningful virtual support to patients across an expansive array of specialties, in all 50 states.

Open Loop’s mission is to bring care anywhere by powering telehealth solutions  are looking for a Manager, Payer Contracting to join our Clinical Compliance team and own the strategy, negotiation, and ongoing management of Open Loop’s payer contracting portfolio.

This role will be responsible for bringing structure and visibility to a complex, evolving contracting environment. You will assess and map our existing payer contracts across entities and markets, determine the appropriate group versus individual contracting approach, and personally lead negotiations and renegotiations with national and regional payers. You will partner closely with Revenue Cycle Management, Payer Enrollment, Finance, Clinical Operations, Compliance, Legal and other teams to ensure contracts are structured correctly and successfully implemented downstream.

This is a highly hands-on role for someone who understands payer contracting from the provider perspective and is comfortable operating independently in an environment where the path may not already be defined.

• Own Open Loop’s payer contracting portfolio, including the identification, organization, assessment, negotiation, implementation, renewal, and ongoing management of payer contracts.

• Build a comprehensive inventory and contracting map across Open Loop entities, identifying existing agreements, contracting entities, payer relationships, state requirements, renewal dates, fee schedules, and gaps requiring remediation.

• Determine the appropriate contracting strategy across group-level and individual provider contracts
  , including when payers require different contracting structures by entity, provider group, market, or state.

• Personally lead payer negotiations and renegotiations, serving as Open Loop’s primary contracting representative with national and regional health plans.

• Negotiate reimbursement rates, fee schedules, contract terms, and other financial arrangements that support Open Loop’s clinical and financial objectives.

• Use utilization, reimbursement, coding, payer mix, and financial data to develop fact-based negotiation strategies and effectively represent Open Loop at the negotiating table.

• Partner with Revenue Cycle Management and coding stakeholders to understand services and codes being billed, identify contracting implications, and ensure agreements appropriately support Open Loop’s care delivery model.

• Collaborate with Payer Enrollment to ensure contracted entities, providers, state identifiers, and enrollment requirements are accurately aligned with payer agreements.

• Coordinate with Revenue Cycle Management, Finance, Clinical Operations, Compliance, and other stakeholders to ensure negotiated contracts are implemented accurately into downstream systems and workflows.

• Evaluate existing contracts to identify opportunities to consolidate, restructure, renegotiate, or transition agreements as Open Loop's organizational structure and payer strategy evolve.

• Support the integration of acquired or newly added businesses into Open Loop’s broader payer contracting strategy, assessing existing payer relationships and determining the appropriate future-state contracting approach.

• Maintain current knowledge of Medicare, Medicaid and Medicaid Managed Care, Medicare Advantage, and commercial reimbursement methodologies and contracting requirements.

• Monitor contract…