Program Lead, Payor Connections/Interoperability

Role overview

Own interoperability programs that improve the acquisition of healthcare data from provider systems for risk adjustment work. The role involves building end-to-end processes in an evolving environment, coordinating internal teams and external partners, and ensuring connections are tested, accurate, and compliant.

Responsibilities - Lead interoperability initiatives, including outreach to provider organizations. - Build working relationships with provider groups and vendors. - Create and maintain project plans and contribute to operational strategy and market approach. - Coordinate testing and validation of data connections for functionality and compliance. - Track delivery, resolve data quality or integration issues, and drive ongoing improvements. - Maintain operational dashboards and adapt them as user needs change.

Requirements - At least three years of healthcare operations or health insurance experience working directly with provider groups. - At least two years delivering interoperability projects or programs. - In-depth knowledge of TEFCA. - Strong analytical skills and ability to work independently through ambiguity. - Ability to coordinate stakeholders and ensure work complies with applicable regulations.

Nice to have

Experience in risk adjustment and basic SQL or BigQuery querying are helpful.

Benefits and work setup

This is a remote role open to candidates in Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia. The listed base salary is $101,844–$133,670 in New York and New Jersey, and $91,659–$120,303 elsewhere. Benefits include medical, dental, and vision coverage, paid holidays and leave, a 401(k), life and disability insurance, wellness time and reimbursements, and annual performance bonuses.