Payer Integration Manager

What you'll do: Manage a high volume of concurrent health plan integration workflows, ensuring seamless coordination between internal stakeholders and external carrier technical contacts. Drive the end-to-end implementation process for payer integrations, overcoming communication or technical barriers to see high-priority data configurations through to completion. Analyze complex backend data structures, implementation protocols, and integration elements—including 837/835 transaction loops, electronic funds transfers (EFT), and provider configuration profiles—to map the most efficient deployment paths. Identify integration, billing, and system configuration risks early in the implementation cycle and proactively implement mitigation strategies. Partner closely with cross-functional technical and non-technical teams to align external payer systems with internal revenue cycle infrastructure. Maintain a deep, updated understanding of funding structures, benefit designs, compliance requirements, and industry-standard integration practices. Execute proactive revenue cycle measures during the onboarding phase to ensure clean upstream configuration, healthy billing habits, and strong financial outcomes. Contribute actively to the continuous improvement of onboarding documentation, deployment checklists, and standard operating procedures to scale our operational efficiency. What success looks like in this role: Integration Velocity: Optimize the time-to-velocity for new configurations by consistently reducing the average days required to kick off data integrations with health plans from initial assignment. On-Time Project Execution: Maintain a strong track record of launching system integrations on or ahead of schedule against established client and health plan implementation milestones. Financial Health & DSO Optimization: Support overall revenue cycle performance by implementing proactive configuration measures that minimize Day Sales Outstanding (DSO) in alignment with company financial health standards. Upstream Quality Assurance: Drive high first-pass claim acceptance rates by identifying and resolving billing loop and eligibility friction points prior to system deployment. Aging Account Risk Mitigation: Proactively manage integration risk and backend infrastructure anomalies to minimize outstanding configurations and resolve system blocks impacting aging accounts receivable buckets. What you'll bring: 3-5 years of relevant professional experience directly managing integrations, implementations, or technical operations with health insurance payers and carriers. Demonstrated data proficiency, with hands-on experience querying data in Snowflake, building or utilizing reporting in Looker, and interpreting metrics to drive decision-making. Strong business acumen and analytical skills, with a proven ability to evaluate dashboard numbers, uncover data insights, and translate reports into concrete action plans. Proven proficiency executing complex, high-volume data integration tasks and projects independently with minimal supervision. Deep knowledge of core health insurance concepts, payer funding structures, health plan benefit designs, and carrier networks. Strong technical understanding of healthcare EDI transaction infrastructure and standards, specifically 837 and 835 claim files, billing loops, in-network processing, and provider configuration profiles. Solid familiarity with general revenue cycle management (RCM) concepts, including claims processing, adjudication, billing regulations, and clearinghouse operations. Excellent communication and cross-functional collaboration skills, with a track record of effectively translating technical integration elements for non-technical partners. Experience with HIPAA regulations and associated compliance guidelines regarding electronic healthcare transactions and protected health information (PHI). Bachelor’s degree in Health Information Management, a related field of coursework, or equivalent practical work experience is preferred. The target base salary range for this position is $80,000 - $92,000 and is part of a competitive total rewards package including benefits. Individual pay may vary from the target range and is determined by a number of factors including experience, location, internal pay equity, and other relevant business considerations. We review all employee pay and compensation programs annually using Radford Global Compensation Database at minimum to ensure competitive and fair pay.