Pearl Health is powering the future of healthcare. We help primary care providers and organizations to deliver quality healthcare to the patients who need it most, when they need it most — and get rewarded for keeping patients healthy.
Our technology, services, and financial tools enable better, more proactive care, decrease total cost of care across patient panels, and optimize performance in value-based care models for Traditional Medicare and Medicare Advantage.
We are a team of physicians and public health experts (Stanford, Harvard, Mount Sinai), technologists (athenahealth, Amazon, Meta, Flatiron), healthcare innovators (Centivo, Aledade, Stellar, Arcadia), and experienced risk management professionals (CVS/Aetna, Humana, Oscar) who believe that primary care providers are the key to addressing our healthcare system’s biggest challenges.
Since its founding in 2020, Pearl has expanded to partner with thousands of primary care providers in practices and organizations across 44 states. Our investors include Andreessen Horowitz, Viking Global Investors, AlleyCorp, and SV Angel.
We are seeking a highly motivated and detail-oriented Payor Operations Support Lead Contractor to support the implementation and ongoing management of our Medicare Advantage contracts. This role is critical to the success of our partnerships and will involve a high degree of cross-functional collaboration with both internal teams and external stakeholders. The ideal candidate will have a strong background in operations, analysis, and health care, with a passion for driving excellence in value-based care.
You will work collaboratively with our SVP, Medicare Advantage, who will help forge internal alignment across our Product, Growth, and Operational teams to empower Pearl to manage and expand key partnerships with Medicare Advantage plans, reinforcing a new line of business for Pearl alongside our traditional Medicare book. We are seeking someone who can nurture critical relationships with plans, and ensure our Medicare Advantage partnerships align with Pearl’s technology priorities and operational capabilities and that they help the company achieve its broader objectives.
Contract Implementation: Support implementation of Medicare Advantage contracts, ensuring that all contractual obligations are met and that our provider partners are fully equipped to succeed.
Data Analysis & Reporting: Conduct in-depth data analysis to monitor contract performance, identify trends, and develop actionable insights. Create regular reports to share with both internal teams and external partners.
Customer Success Support: Collaborate with the Customer Success team to ensure they are trained and equipped to support our provider partners effectively under the Medicare Advantage contracts. Develop and implement training programs as needed.
Continuous Improvement: Continuously evaluate and improve operational processes to enhance efficiency, contract performance, and provider satisfaction.
3+ years of experience in operations, network management, or other relevant payor facing field. Experience with ACOs is a plus.
Excellent communication, interpersonal and presentation skills.
Experience working in a cross-functional environment with both internal and external stakeholders.
Exceptional communication and interpersonal skills, with the ability to build strong relationships at all levels.
Knowledge of value-based care models and Medicare Advantage plans is preferred.
Bachelor’s degree or equivalent work experience.
We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Our definition of diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. We believe all of our colleague’s points of view are integral to our success, and that inclusion is everyone's responsibility and a cause of beautiful things.
We welcome candidates from all backgrounds and are committed to a fair hiring process free from discrimination and focused around problem solving, improvement, and mutual empowerment.
The salary band for this position is $35 - $55 per hour. The expectation for this contract position is to work 20 hours/week, with an anticipated timeline of April 2025 - July 2025.
We are not currently working with contingency search firms. If a resume is submitted to any Pearl Health employee by a third party without a valid written and signed search agreement, it will become the property of Pearl Health and no fee will be paid, irrespective of whether the candidate is hired.
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