Director, Payor Operations

Director, Payor Operations About Equip Equip is the leading virtual, evidence-based eating disorder treatment program on a mission to ensure that everyone with an eating disorder can access treatment that works. Created by clinical experts in the field and people with lived experience, Equip builds upon evidence-based treatments to empower individuals to reach lasting recovery. All Equip patients receive a dedicated care team, including a therapist, dietitian, physician, and peer and family mentor. The company operates in all 50 states and is partnered with most major health insurance plans. Learn more about our strong outcomes https://equip.health/outcomes and treatment approach at www.equip.health. http://www.equip.health Founded in 2019, Equip has been a fully virtual company since its inception and is proud of the highly-engaged, passionate, and diverse Equisters that have created Equip’s culture.  Recognized by Time https://time.com/collection/time100-companies-2023/6285207/equip/ as one of the most influential companies of 2023, along with awards from Linkedin https://www.linkedin.com/pulse/linkedin-top-startups-2022-50-us-companies-rise-linkedin-news/ and Lattice https://lattice.com/blog/announcing-the-2023-finalists-for-lattices-people-success-awards, we are grateful to Equipsters for building a sustainable treatment program that has served thousands of patients and families. About the role The Director of Payor Operations will be responsible for building and leading the operational infrastructure that enables high-quality, compliant, and scalable care delivery across Equip’s commercial and Medicaid health plan partnerships. This role will sit at the intersection of Payor Partnerships, Care Delivery, Legal, and Finance to translate health plan contract requirements into day-to-day execution, ensuring we deliver care in accordance with contractual requirements while optimizing access and reimbursement. Responsibilities - Partner with cross functional leaders to ensure internal processes and care delivery are in accordance with health plan needs across commercial and Medicaid lines of business - Translate health plan contracts, provider manuals, and regulatory requirements into scalable operational workflows - Serve as the internal subject-matter expert on credentialing and payor operational requirements - Oversee the Credentialing team to ensure providers are enrolled, credentialed, and re-credentialed across all contracted payors, including Medicaid, in a timely and compliant manner. - Partner cross-functionally with various teams including Care Delivery, Care Operations, Payor Partnerships, Revenue Cycle, and Legal to ensure operational readiness and alignment with existing payor contract obligations, current and new regulatory requirements, and new payor implementations and market expansion. - Provide operational insight and data to support payor performance discussions and contract optimization. - Establish KPIs and develop reporting mechanisms to track performance for credentialing and overall payor operations. - Identify operational risks and process inefficiencies and lead remediation efforts as needed. - Support payor audits, payor reviews, and regulatory or compliance inquiries as needed. - Perform other duties as assigned. Qualifications - 8+ years of experience in payor operations, managed care operations, or healthcare administration. - Demonstrated experience and expertise with commercial health plans and Medicaid, including regulatory and compliance requirements. - Proven leadership experience managing operational teams in a fast-paced environment. - Strong cross-functional collaborator who can partner effectively with clinical and operational stakeholders. - Experience in healthcare startups or high-growth environments strongly preferred. - Ability to translate complex contracts and regulations into clear, executable workflows. Time Off: - Flex PTO policy (3-5 wks/year recommended ... (truncated, view full listing at source)