Founding Payer Operations and Growth Lead [Operations / Growth / Finance]

Founding Payer Operations and Growth Lead [Operations / Growth / Finance]

Location: US / Remote / San Francisco, CA / Austin, TX

Job Type: Full-time

Experience: 3+ years

Compensation: $70K - $150K / 0.1% - 0.5% Equity

About Legion Health

Legion Health is building a high-quality, AI-native psychiatry network where patients receive care from providers who accept their insurance. Backed by Y Combinator and top-tier VCs, we aim to integrate AI and technology into nearly every facet of psychiatric care, enhancing both access and treatment outcomes.

About the Role

As the Founding Payer Operations and Growth Lead, you will play a pivotal role in shaping and managing Legion Health’s relationships with insurance payers. You will focus on improving payer engagement, streamlining credentialing processes, negotiating reimbursement rates, and ensuring compliance across all payer operations. This role combines operational expertise, sales, and strategic thinking to optimize payer partnerships and support Legion Health’s growth trajectory. You should be willing to get your hands dirty and deeply understand aspects of finance, revenue operations, and revenue cycle management, and work with product and operations teams to automate processes or build operations as needed.

Key Responsibilities:

• Payer Rate Negotiations: Drive payer rate renegotiations by highlighting Legion Health's value, including ROI metrics, clinical outcomes, and patient satisfaction scores (e.g., NPS). Leverage advisory boards and industry experts to strengthen negotiations and secure improved reimbursement rates.
• Patient Routing and Navigation Partnerships: Build relationships with payer care coordination, disease management, and referral teams to drive patient volume. Establish Legion Health as a preferred provider for mental health services on payer portals and routing systems.
• Directory Optimization: Audit and enhance directory listings on payer websites and member portals to increase patient volume. Partner with payer network teams to ensure accurate and prominent placement in provider search tools.
• Government Payer Expansion: Manage relationships with Medicare, Medicare Advantage, TRICARE, and Medicaid to expand coverage and ensure compliance with state-specific regulations.
• Delegated Credentialing Agreements: Secure delegated credentialing agreements with commercial payers to accelerate provider onboarding and streamline operations. Ensure compliance with NCQA and CMS standards while scaling the process.
• National Insurance Contracts: Develop relationships with C-level executives and network teams at major payers to pursue national contracts. Showcase operational excellence and clinical impact to secure streamlined contracting and credentialing processes across multiple states.
• Audit and Risk Management: Conduct regular audits of payer contracts, operational processes, and compliance systems to mitigate risk and ensure adherence to federal and state regulations.
• Revenue Cycle Optimization: Identify bottlenecks and inefficiencies in revenue cycle workflows. Collaborate with product and engineering teams to develop automated solutions that improve claim submission accuracy, reduce errors, and increase collection rates.
• Partnerships with IPAs and CINs: Build relationships with Independent Physician Associations (IPAs) and Clinically Integrated Networks (CINs) to secure higher payer rates and access collaborative opportunities that benefit providers and patients.
• Strategic State Expansion: Lead multi-state payer contracting efforts by managing licensing, credentialing, and compliance requirements. Evaluate and prioritize states with high growth potential and favorable reimbursement rates.
• Data-Driven Decision-Making: Leverage analytics to assess payer performance, measure patient engagement, and inform strategic decisions. Use insights to refine payer strategies and improve financial outcomes.
• Industry Trend Monitoring: Stay informed on payer strategies, healthcare policy changes, and advancements in AI to maintain a competitive edge.

Qualifications:

• 3+ years of experience in payer strategy, revenue cycle management, or healthcare operations, with a proven track record in driving growth and optimizing financial outcomes. Experience in healthcare startups is a plus.
• Demonstrated expertise in payer contracting, rate negotiations, and credentialing, with a deep understanding of commercial and government payer systems, including Medicare and TRICARE.
• Strong ability to build and maintain strategic relationships with payer network executives, including VPs of Network, care coordination teams, and other decision-makers.
• Comprehensive knowledge of CPT codes, reimbursement models, and payer-specific billing practices, with hands-on experience solving claims issues and optimizing collections.
• Strong understanding of partnership-building and experience collaborating with tech and product teams to improve operational processes.
• Exceptional project management and organizational skills, with the ability to prioritize and execute multiple initiatives in a fast-paced environment.
• Proven success in leveraging data and analytics to inform payer strategies, monitor key metrics, and make data-driven decisions to improve financial performance.
• Exceptional interpersonal and leadership skills, with the ability to collaborate effectively across internal and external teams.
• Excellent communication and presentation skills, capable of clearly articulating value propositions to payers and internal stakeholders.
• Proactive and adaptable mindset, thriving in a fast-paced, tech-driven startup environment.

Our Values:

• Patient Focus: We prioritize our patients' and clinicians' needs, using product and tech innovations to continuously improve their experience.
• High-Velocity Execution: We thrive in a fast-paced environment, leveraging technology to deliver results quickly and efficiently.
• Empathy: We care deeply about our patients, providers, and team members, focusing on building solutions that create a supportive environment.
• Entrepreneurial Spirit: We embrace ownership, accountability, and innovation, navigating uncertainty with confidence through product-driven solutions.
• Transparency: We value clarity, openness, and effective communication across all levels of the organization.

Join us at Legion Health and be part of a mission to improve mental health care for millions through the integration of advanced technology, product innovation, and exceptional service.

About the Hiring Process:

• Pre-Screening Questions: Short questions to determine fit.
• Initial Interview: Initial call with the CEO.
• Case Study/Technical Interview: Deep dive into your experience with tech, product, and operational problem-solving. Tackle a real-world problem related to revenue cycle tech and product integration.
• Interview with all Co-Founders: Discuss vision, motivation, and overall fit.
• Reference Checks: Confirm past achievements and qualifications.