The Role

Thirty Madison’s mission is to make specialized care and treatment accessible to everyone. As we continue to expand our current offerings and launch new therapeutic areas in more complex conditions, accepting health benefits and developing alternative coverage models will have a meaningful impact on ensuring that the maximum number of people have access to care from Thirty Madison. 

We are looking for a dynamic and experienced leader to help stand up the operational infrastructure needed to better integrate with the healthcare system.  This role will report directly to our GM, Platform, and work closely with department leads and their business unit counterparts. Responsibilities will include helping to scope and own the development of new platform capabilities related to network contracting, eligibility verification and billing, and supporting the documentation and dissemination of Thirty Madison best practices for these new functions. This person will need to serve as a strategic thought partner across the organization. This role is based in New York, with location flexibility in the near term.

You’re the right person for the role if you are:

• You have experience starting functions and building teams, and are confident in your ability to help create the operational support related to insurance, credentialing, billing, and coding at Thirty Madison. 
• You will be able to make build vs. buy decisions and continually iterate to make sure the function can scale.
• You are comfortable supporting negotiations with health plans, employers and PBMs
• You love using data to help answer questions, and can translate reports into process improvements
• You have worked at the intersection of sales and operations before, and understand the dynamics of account management - perhaps you’ve led negotiations or accounts before
• You love and understanding healthcare, and can geek out on fee-for-service and value-based insurance reimbursement processes

Some things you will work on:

• Secure payor contracts for our medical group, through both network applications and development conversations
• Negotiate contracts to help achieve goals surrounding reimbursement rates and revenue targets for insurance-based product lines. Build close ties with payors to support future vision of value-based contracting.
• Support our business unit teams in securing employer and benefits contracts
• Help our pharmacy team with contracting relationships with PBMs, as well as insurance processing
• Build a team from the ground up to support new functionality and operations related to third-party reimbursement
• Partner closely with our product and engineering teams to put in the place the needed systems and integrations to support insurance reimbursement and employer contracting
• Work closely with our Care Team to ensure our member experience is universal, regardless of payment model
• Collaborate with our medical operations team to credential and enroll our providers, and manage licensure
• Support on-going business development efforts to expand access to Thirty Madison’s programs through insurance
• As a member of the Platform leadership team, help ensure the organization is continually evolving its capabilities

Qualifications / What skills do I need? / You’ll be successful in this role if you have…

• 7+ years of operational experience in a healthcare environment, ideally a provider group or health plan
• Experience with network contracting, provider credentialing, claims processing and revenue cycle management
• Experience and genuine interest in managing a new and growing team
• Confirmed data retrieval, analytics, and presentation skills. You should know how to tell a story with data and insights
• The ability to zoom in and out (oscillating between tactical and strategic) and context-switch with ease
• The desire to help drive positive health outcomes for our customers