Is the Manager, Payor Contract Integrity & Delegation Operations position at Advanced Medical Management fully remote?

Yes, this Manager, Payor Contract Integrity & Delegation Operations position at Advanced Medical Management is a remote position. The role is available for candidates in United States.

Is this a full-time or part-time Manager, Payor Contract Integrity & Delegation Operations role?

This is a full-time Manager, Payor Contract Integrity & Delegation Operations position at Advanced Medical Management.

What benefits does Advanced Medical Management offer for this position?

Advanced Medical Management offers the following benefits: Wellness Programs, Paid Time Off, Tuition Reimbursement.

How do I apply for the Manager, Payor Contract Integrity & Delegation Operations position at Advanced Medical Management?

You can apply for this Manager, Payor Contract Integrity & Delegation Operations position by clicking the "Apply Now" button on this page, which will take you to Advanced Medical Management's application portal.

Manager, Payor Contract Integrity & Delegation Operations at Advanced Medical Management

United States

$125k - $150k

<div><h2 style="margin-left:0in;" data-pasted="true"><span style="font-family: arial, sans-serif; font-size: 14px;">Overview</span></h2><p style="margin-left:0in;"><span style="font-family: arial, sans-serif; font-size: 14px;">Seoul Medical Group (SMG) is seeking a highly analytical and detail-oriented Manager, Payor Contract Integrity & Delegation Operations to serve as the operational bridge between payors, contracting, healthcare economics, finance, and MSO teams.<br> <br> This role is responsible for ensuring that capitation payments and claims-based reimbursements are accurate and aligned with contracted terms, and that delegated, capitated risk contracts are implemented correctly within MSO systems and Delegated Configuration, including DOFR alignment.<br> <br> The individual will not perform system configuration directly but will project manage implementation, validate alignment to contract terms, and coordinate cross-functional communication to ensure financial and operational accuracy.</span></p><h2 style="margin-left:0in;"><span style="font-family: arial, sans-serif; font-size: 14px;">Key Responsibilities</span></h2><div style="margin-left:0in;"><ul style="list-style-type: disc;margin-left: -0.25in;"><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Serve as primary liaison with payors to identify and resolve capitation discrepancies, claims underpayments, and overpayments.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Partner with Healthcare Economics and Finance to reconcile capitation models against actual payment files.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Analyze payment variances and validate alignment to contracted rates, attribution models, and DOFR terms.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Escalate discrepancies to payors and manage issue resolution through completion.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Translate contract language (risk terms, DOFR allocations, carve-outs, fee schedules) into implementation requirements.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Partner with Payor Contracting to ensure newly executed contracts are accurately operationalized.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Coordinate with the AMM MSO team and Delegated Configuration teams to ensure capitated contracts are configured properly.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Project manage contract implementation timelines and ensure cross-functional alignment.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Validate system configuration reflects negotiated contract terms prior to go-live.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Develop structured processes for post-implementation validation of capitated and delegated contracts.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Identify financial risk exposure due to misconfiguration or payment inaccuracies.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Support audit readiness related to delegated and capitated arrangements.</li></ul></div><h2 style="margin-left:0in;"><span style="font-family: arial, sans-serif; font-size: 14px;">Qualifications</span></h2><div style="margin-left:0in;"><ul style="list-style-type: disc;margin-left: -0.25in;"><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Bachelor’s degree required; advanced degree preferred.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">5+ years of experience in payor contracting operations, healthcare economics, capitation reconciliation, delegated risk operations, or MSO finance.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Strong working knowledge of capitated payment structures, risk-bearing provider contracts, and DOFR frameworks.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Demonstrated experience managing cross-functional implementation projects.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Strong Excel and financial analysis skills.</li></ul></div><h2 style="margin-left:0in;"><span style="font-family: arial, sans-serif; font-size: 14px;">Preferred Qualifications</span></h2><div style="margin-left:0in;"><ul style="list-style-type: disc;margin-left: -0.25in;"><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Experience within an IPA, MSO, health plan, or delegated risk organization.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Familiarity with delegated configuration systems and contract loading workflows.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Exposure to Medicare Advantage financial models, Stars, or risk adjustment.</li><li style="margin-left: 0in; font-family: arial, sans-serif; font-size: 14px;">Experience resolving payment disputes with payors.</li></ul><p data-pasted="true" style='box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; margin-top: 0px; margin-bottom: 1rem; line-height: 1.25; color: rgb(38, 35, 33); font-family: Circular, -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; background-color: rgb(255, 255, 255);'><span style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; font-size: 14px; font-family: arial, sans-serif;"><strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;"><u style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">AMM BENEFITS</u></strong></span></p><p style='box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; margin-top: 0px; margin-bottom: 1rem; line-height: 1.25; color: rgb(38, 35, 33); font-family: Circular, -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; background-color: rgb(255, 255, 255);'><span style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; font-size: 14px; font-family: arial, sans-serif;">When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:</span></p><ul type="disc" style='box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; color: rgb(38, 35, 33); font-family: Circular, -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Fira Sans", "Droid Sans", "Helvetica Neue", sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; background-color: rgb(255, 255, 255);'><li style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; font-size: 14px; font-family: arial, sans-serif;"><strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">Health Coverage You Can Count On</strong>: Full employer-paid <strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">HMO</strong> and the option for a <strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">flexible PPO plan</strong>.</li><li style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; font-size: 14px; font-family: arial, sans-serif;"><strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">Wellness Made Affordable</strong>: Discounted <strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">vision and dental premiums</strong> to help keep you healthy from head to toe.</li><li style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; font-size: 14px; font-family: arial, sans-serif;"><strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">Smart Spending</strong>: <strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">FSAs</strong> to manage healthcare and dependent care costs, plus a <strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">401(k)</strong> to secure your future.</li><li style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; font-size: 14px; font-family: arial, sans-serif;"><strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">Work-Life Balance</strong>: Generous <strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">PTO</strong>, <strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">40 hours of sick pay</strong>, and <strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">13 paid holidays</strong> to enjoy life outside of work.</li><li style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; font-size: 14px; font-family: arial, sans-serif;"><strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">Career Development</strong>: <strong style="box-sizing: border-box; outline: none; --tw-shadow: 0 0 #0000; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgba(59,130,246,.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000;">Tuition reimbursement</strong> to support your education and growth.</li></ul></div></div>

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Remote Opportunity

Manager, Payor Contract Integrity & Delegation Operations

Q: What are the main requirements for the Manager, Payor Contract Integrity & Delegation Operations role?

Key requirements include: 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., and more.

Q: What is the salary range for the Manager, Payor Contract Integrity & Delegation Operations position?

The salary range for this Manager, Payor Contract Integrity & Delegation Operations role is $125k - $150k.

Join Advanced Medical Management as a senior professional working remotely from United States. Explore the role, benefits, and apply in one place.

Manager, Payor Contract Integrity & Delegation Operations

Advanced Medical Management

Full Time

$125k - $150k

6 months ago

Overview Seoul Medical Group (SMG) is seeking a highly analytical and detail-oriented Manager, Payor Contract Integrity & Delegation Operations to serve as the operational bridge between payors, contracting, healthcare economics, finance, and MSO teams.

United States

Operations

Senior

issue resolution

Financial Analysis

Project Management

+5 more

Job Description

Overview

Seoul Medical Group (SMG) is seeking a highly analytical and detail-oriented Manager, Payor Contract Integrity & Delegation Operations to serve as the operational bridge between payors, contracting, healthcare economics, finance, and MSO teams.

This role is responsible for ensuring that capitation payments and claims-based reimbursements are accurate and aligned with contracted terms, and that delegated, capitated risk contracts are implemented correctly within MSO systems and Delegated Configuration, including DOFR alignment.

The individual will not perform system configuration directly but will project manage implementation, validate alignment to contract terms, and coordinate cross-functional communication to ensure financial and operational accuracy.

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.
Coordinate with the AMM MSO team and Delegated Configuration teams to ensure capitated contracts are configured properly.
Project manage contract implementation timelines and ensure cross-functional alignment.
Validate system configuration reflects negotiated contract terms prior to go-live.
Develop structured processes for post-implementation validation of capitated and delegated contracts.
Identify financial risk exposure due to misconfiguration or payment inaccuracies.
Support audit readiness related to delegated and capitated arrangements.

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

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

Health Coverage You Can Count On: 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.
Career Development: Tuition reimbursement to support your education and growth.

Requirements

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.
Ability to serve as primary liaison with payors to identify and resolve capitation discrepancies, claims underpayments, and overpayments.
Ability to analyze payment variances and validate alignment to contracted rates, attribution models, and DOFR terms.

Benefits

Wellness Programs
Paid Time Off
Tuition Reimbursement

Skills

issue resolution

Financial Analysis

Project Management

Payor Contract Integrity

Delegation Operations

Capitation Payments

Claims Reimbursement

Contract Alignment

Ready to Apply?

Join Advanced Medical Management today

Salary Range

$125k - $150k

Posted 6 months ago

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