Payer Growth and Operations Director

Everly Health

Everly Health

Sales & Business Development, Operations
Austin, TX, USA
Posted on Friday, October 27, 2023
Everly Health's mission is to transform lives with modern, diagnostics-driven care, and we believe that the future of healthcare is meeting people where they are. Headquartered in Austin, Texas, Everly Health is the parent company to Everlywell, Everly Health Solutions, Natalist, and Everly Diagnostics. We've set a new standard of people-focused, diagnostic-driven care that puts patients at the center of their own health journey.
Our infrastructure guides the full testing experience with the support of a national clinician network that's composed of hundreds of physicians, nurses, genetic counselors, PharmDs, and member care specialists. Our solutions make world-class virtual care more attainable with rigorous clinical protocols and best-in-class science to tackle some of the healthcare industry's biggest problems.
Responsible for providing strategic leadership and direction for all Enterprise Operations Strategy related activities, including but not limited to: developing and implementing payer strategy; building payer relationships; negotiating payer contracts; driving strategic market share growth; optimizing reimbursement rates and contract language; performing financial analysis; and other payer strategy and relationship related activities.
The Payer Growth and Operations Director will be responsible for driving the company’s efforts to expand its in-network presence with payers, including driving any strategic initiatives that these contracts require. The individual will research, identify, and initiate conversations with targeted payers, guiding our enterprise telehealth company through the necessary processes to be in-network. The ideal candidate has strong knowledge of the healthcare payer landscape, particularly in telehealth, and possesses stellar relationship-building skills.

Responsibilities:

  • Work with VP Sales and Growth to: Develop and implement a strategy for enterprise business focused on payer initiatives that differentiates and increases market share
  • Drive Payer strategic initiatives that are essential for growth including operationalization of reimbursement strategy, including but not limited to; setting Everly up as an in-network provider, establishment of different coding and launch of coding testing
  • Research and identify key payers within the enterprise telehealth space.
  • Evaluate potential payer partnerships based on company strategy and revenue potential.
  • Develop and maintain a clear process and timeline for becoming in-network with each payer.
  • Drive decision making in a matrix organization ensuring alignment with key stakeholders
  • Initiate and foster relationships with payer decision-makers.
  • Ensure smooth integration of payer requirements within our physician network.
  • Collaborate with internal teams to align payer needs with our services.
  • Stays current with emerging payer trends, new reimbursement methodologies, and State and National regulatory issues, plan benefits, payer activity, products and delivery channels including health insurance exchanges, market competition, etc.
  • Participates in establishing the composition, pricing, and management of fee and value-based payment and risk arrangement
  • Monitor the in-network process continuously for improvements.

Who you are / Job Requirements:

  • Bachelor’s degree in business, finance, healthcare or a related field from an accredited college or university; Master’s degree preferred
  • Fifteen years of professional experience in business, operations, healthcare, consulting, or a related field, including at least 5 years of experience in healthcare. Professional experience in payer/provider strategy or operations highly preferred
  • Well-versed and experienced in business planning including the development of go to market and operational plans.
  • Ability to execute on go to market and business plans in a cross functional approach to maximize market opportunity
  • Ability to view scenarios/ products/ situations from a high level strategic viewpoint to inform strategic thinking and problem solving
  • Deep knowledge of finance, business and business revenue models
  • Experience and knowledge in stakeholder management
  • Strong facilitation capabilities and business value acumen
  • Interpersonal skills with the ability to negotiate, influence and build trust with internal and external stakeholders

Skills & Abilities Required:

  • Creation of clear and actionable plans and ongoing management of execution of plans
  • Leading cross functional teams during execution and management of ongoing process and operations for provider and payer integrations
  • Exception ability to communicate and develop materials using standard professional software and technology for internal and external stakeholders
You'll Love Working Here:
· Venture backed by top-tier firms
· The opportunity ahead knows no bounds
· Open vacation policy for salaried team members
· Front Loaded PTO for hourly team members
· Employee discounts
· Paid parental leave
· Health benefits
· 401(k)
NO EXTERNAL RECRUITERS - INDIVIDUAL APPLICANTS ONLY
Everly Health is committed to providing equal employment opportunities in all employment practices. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, citizenship status, marital status, age, disability, protected veteran status, sexual orientation or any other characteristic protected by law.
HIPAA Disclaimer: This role will be in an environment that has access to protected health information (PHI) and all security standards to protect PHI must be followed.