Payer Operations Specialist

Reporting to the Senior Manager, Payer Operations, the Payer Operations Specialist will manage and support payer partners to ensure smooth operational performance. This full time, remote role is part of the Payer Operations team and plays a critical role in enabling clean claims, optimizing payer workflows, and driving scalable improvements across revenue operations.

What You’ll Be Doing

• Collect, analyze, and interpret clinical, operational, and financial data to assess payer performance and trends.
• Monitor KPIs such as DSO, denial volume, and claim routing accuracy, flagging anomalies or discrepancies to the broader team.
• Assist with the creation and maintenance of automated and self-refreshing KPI dashboards.
• Support audit preparation and reconciliation efforts by pulling reports and validating data sets.
• Collaborate with IC3+ team members on new integrations, payer escalations, or special projects through research, timeline tracking, and administrative setup.
• Coordinate project milestones, risks, and deliverables, surfacing issues when timelines or inputs are at risk.
• Facilitate information flow and handoffs across internal teams including Billing, RCM, Product, and Legal.
• Maintain SOPs, payer playbooks, internal how-to guides, and reference materials.
• Standardize and centralize payer account information (e.g., routing rules, modifier requirements, prior auth logic).
• Document meeting notes, decisions, and follow-ups to ensure accountability and next steps.
• Execute recurring workflows that support clean claims, reduced DSO, and payer performance health.
• Translate front-line payer knowledge into scalable process improvements.

What success looks like:

• Clean, timely claim submissions across assigned payer accounts
• DSO reduction and denial volume trending downward quarter-over-quarter
• KPI dashboards updated weekly with high data accuracy
• SOPs and payer documentation maintained and up to date across all assigned accounts
• Cross-functional teams aligned on launch readiness and ongoing workflows

What you’ll bring:

• 1–3 years of experience in healthcare operations, revenue cycle, payer integrations, or data analysis
• Strong analytical skills with working knowledge of Excel/Google Sheets
• Excellent attention to detail, organizational skills, and follow-through
• A systems thinker who’s eager to learn, contribute, and grow within a fast-paced environment
• Strong written communication skills for internal documentation and reporting

Nice to have:

• Experience using BI tools such as Looker or Tableau
• Familiarity with payer setup workflows or integration processes
• Exposure to healthcare claims systems or revenue operations tools

The target base salary range for this position is $32.05 - 39.62 per hour and is part of a competitive total rewards package including stock options and benefits. Individual pay may vary from the target range and is determined by a number of factors including experience, location, internal pay equity, and other relevant business considerations. We review all employee pay and compensation programs annually using Radford Global Compensation Database at minimum to ensure competitive and fair pay.

Benefits provided by Spring Health:

Note: We have even more benefits than listed here and below, your recruiter will provide more in-depth information as you continue in the interview process. Benefits are subject to individual plan requirements and eligibility criteria.

• Health, Dental, Vision benefits start on your first day at Spring. You and your dependents also receive access to One Medical accounts HSA and FSA plans are also available, with Spring contributing up to $1K for HSAs, depending on your plan type.
• Employer sponsored 401(k) match of up to 2% for retirement planning
• A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents.
• We offer competitive paid time off policies including vacation, sick leave and company holidays.
• At 6 months tenure with Spring, we offer parental leave of 18 weeks for birthing parents and 16 weeks for non-birthing parents.
• Access to Noom, a weight management program—based in psychology, that’s tailored to your unique needs and goals.
• Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses.
• Access to Wellhub, which connects employees to the best options for fitness, mindfulness, nutrition, and sleep in one subscription
• Access to BrightHorizons, which provides sponsored child care, back-up care, and elder care
• Up to $1,000 Professional Development Reimbursement a year.
• $200 per year donation matching to support your favorite causes.