Manager, Payor Contract Integrity & Delegation Operations

Key Responsibilities

• Serve as primary liaison with payors to identify and resolve capitation discrepancies, claims underpayments, and overpayments.
• Partner with Healthcare Economics and Finance to reconcile capitation models against actual payment files.
• Analyze payment variances and validate alignment to contracted rates, attribution models, and DOFR terms.
• Escalate discrepancies to payors and manage issue resolution through completion.
• Translate contract language (risk terms, DOFR allocations, carve-outs, fee schedules) into implementation requirements.
• Partner with Payor Contracting to ensure newly executed contracts are accurately operationalized.
• Career Development: Tuition reimbursement to support your education and growth.

Qualifications

• Bachelor’s degree required; advanced degree preferred.
• 5+ years of experience in payor contracting operations, healthcare economics, capitation reconciliation, delegated risk operations, or MSO finance.
• Strong working knowledge of capitated payment structures, risk-bearing provider contracts, and DOFR frameworks.
• Demonstrated experience managing cross-functional implementation projects.
• Strong Excel and financial analysis skills.
• Preferred Qualifications: Experience within an IPA, MSO, health plan, or delegated risk organization. Familiarity with delegated configuration systems and contract loading workflows. Exposure to Medicare Advantage financial models, Stars, or risk adjustment. Experience resolving payment disputes with payors.

AMM BENEFITS

• Health Coverage: Full employer-paid HMO and the option for a flexible PPO plan.
• Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.