Director, Payer Management

Teladoc Health is a global, whole person care company made up of a diverse community of people dedicated to transforming the healthcare experience. As an employee, you’re empowered to show up every day as your most authentic self and be a part of something bigger – thriving both personally and professionally. Together, let’s empower people everywhere to live their healthiest lives.

Summary of Position

Under the general direction of the VP, Client Operations Architect, the Director, Payer Management will serve as the operational subject matter expert (SME), and manage a team of Payer Management Analysts, responsible for managing Teladoc Health’s relationships with health plans and Government and Private payers, including fee schedule negotiations and reimbursement strategies, member eligibility, benefit administration, provider network management (including participating provider agreements) and billing/claims-related payment issues.  The initial focus of this role will be to work with the RCM team to determine root cause of claim balances, determine root cause, and work directly with the health plans to mitigate financial risk.

The Director, Payer Management is responsible for being a voice to inform and influence strategy on opportunities and requirements for product evolution and development activities to align with telehealth provider network expansion, value-based care opportunities and reimbursement strategies. The Director, Payer Management, supports Hospital & Health System (HHS) customers’ understanding of telehealth reimbursement arrangements for Government and Private payers, to help drive telehealth investment decisions and clinical program priorities across the care continuum.

This position collaborates with Government Affairs to understand potential changes to telehealth reimbursement and provide support to evaluate proposed changes at the federal and state levels that influence telehealth advocacy and policy regulations. The Director, Payer Management will also collaborate with the Revenue Cycle Management/Finance and Provider Operations to ensure telehealth services are accurately and timely reimbursed according to contract.

The ideal candidate will:

• Have expert understanding of the complexities of payer eligibility and reimbursement arrangements, value-based care and benefits administration for Medicare FFS and Medicare Advantage, Medicare FFS and Managed Care, and Commercial payers (HMOs, PPOs).
• Have strong leadership skills and a strategic mindset to understand the potential implications and impact of payer management issues on telehealth program decisions.
• Be highly collaborate, customer-centric, resourceful, and responsive working in a fast-paced and evolving policy and reimbursement landscape for telehealth.

Essential Duties and Responsibilities

• Payer Management
  • Overall responsibility for participating provider agreements, including initiating contract discussions, leading contract discussions and continued evaluation of provider network management and coordinating with legal team.
  • Negotiate fee schedules and contractual terms and conditions for Medicare Advantage, Medicaid Managed Care and Commercial payers (HMOs, PPOs).
  • Responsible for working directly with health plans to mitigate financial risk associated with denied claims.  Including determining root cause and working with both internal and external partners to resolve.
  • Serve as liaison between internal teams and the health plans in support of various benefit plan designs. This would include benefit setup, eligibility, and payer administrative claims issues.
  • Coordinate configuration of payer benefit designs and associated member responsibility to ensure accurate and timely payment.
  • Determine and document requirements by payer for seamless access to care and maximizing revenue. This would include plan design, eligibility, provider network requirements, and claims adjudication.
  • Establish reporting metrics and dashboards to monitor and analyze payer payments, including utilization and payment by specialty and/or product.
  • Monitor overall contract compliance by payer as it relates to payment and terms and conditions.  
  • Create and maintain reference materials, resources, and best practice tools for telehealth payer requirements and reimbursement arrangements that support internal product and solution evaluations and provide value-added services to drive customer success and engagement.
  • Establish, monitor, and maintain the provider to payer relationship for telehealth with multiple health plans for multiple lines of business.
• Strategic Analysis
  • Develop v