Provider Payment Performance, Senior Manager

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

A bit about this role:

• The Provider Payment Performance Senior Manager will play a key leadership role in monitoring and managing contracted provider payment rates for the health plan.

• This position is responsible for identifying and addressing opportunities to ensure both the accuracy of denials and the financial health of the plan’s provider network.

• When payment rates or denial trends are concerning, the Senior Manager will investigate underlying causes, work with internal teams and contracted providers to develop actionable recommendations to address the issues—ultimately driving both payment accuracy and provider performance improvements.

Your Responsibilities and Impact will include:

• Proactively monitor provider performance and provide actionable insights to leadership and the Payment teams to resolve issues and improve payment accuracy.

• Perform in-depth analyses to identify the root causes of high denial rates, including coding errors, billing practices, policy adherence or medical necessity determinations.

• Regularly report on payment rate performance and claims denial trends to senior management, offering insights and proposing solutions for continuous improvement.

• Provide ongoing feedback to internal stakeholders on how to streamline payment processes, improve claim submission accuracy, and reduce unnecessary denials.

• Lead the development of reporting dashboards and key performance indicators (KPIs) to monitor provider payment rates, claim denial trends, and related operational metrics.

• Develop ad hoc reports as needed to support decision-making and problem-solving related to provider payment rates and claims management.

• Serve as a subject matter expert on claims denials and provider payment rate issues, leading internal teams through corrective actions and process optimization.

Required skills and experience:

• Strong understanding of Medicare claims processing, provider payment models, and contractual agreements.

• 5-10 years of Healthcare Experience.

• Advanced proficiency with data analysis tools (Excel, SQL, Tableau), and reporting systems.

• Excellent analytical skills, with the ability to interpret complex data, identify trends, and provide actionable insights.

• Ability to collaborate effectively with cross-functional teams (e.g., Claims, Contracting,

• Provider Services, Compliance) and external providers.

• Strong communication and presentation skills, with the ability to explain complex payment and claims issues to both internal stakeholders and external providers.

Desired skills and experience:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field preferred.

• Certification in Health Insurance, Medical Coding, Claims Management or Revenue Cycle

• Management (e.g., CRCP, CPC, CHC, AAPC).

• Familiarity with root cause analysis methodologies and process improvement techniques (e.g., Six Sigma, Lean).

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Salary range: $105,000 - $155,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off