Who We Are At Sprout Therapy:
Sprout Therapy is a tech-forward provider of pediatric therapy across the United States. We believe that families, clinicians, and insurers all deserve a better healthcare experience, so we built one.
Backed by >$30mm from General Catalyst, Felicis Ventures, Founders Fund, & others. Our mission is to provide personalized, technology-empowered care for children with autism in the environment best suited to help them grow and thrive — the home. We’re looking to rapidly grow our team with values-driven, diverse, caring professionals to help us improve autism care.
About the Role
The Payer Profile Administrator role is to research, compile and maintain critical payer data as it relates to our business. Sprout is rapidly growing into new markets and entering contracts with many varying payers. The payer profile administrator is responsible for the integrity of specific payer related data that is used daily to drive our business.
What You’ll Do:
We are looking for an individual that will take ownership of gathering, validating, inputting, and maintaining critical data areas including but not limited to the following:
- Payer Fee Schedules
- Payer Medical and Coverage guidelines and criteria
- Payer Prior Authorization requirements and protocols
- Payer documentation and forms required to provide and bill for services
- Payer utilization limits and timeframes
- Payer claims processing and billing requirements
- Establish Payer ETF Banking process
- Establish Payer ERA process
- Establish Payer web portal access
- Provide monthly report out on updated payers and changes made
- Provide upcoming payer data clean up projects and estimated completion date
- Research ad hoc inquires related to payer behavior and processing.
- Report to supervisor / manager any problems or issues that result in poor payer data integrity
What You’ll Need:
- Remote work from home, requires reliable intranet and acceptable work from home setting.
- Must be a self-starter, working well without in person supervision
- High School graduate with 3-years’ experience in a health care related field, preferably related to billing or prior authorization policies
- Must be able to perform own’s research and have experience is using varying methods to obtain payer related data including payer portals, effective google searches, blogs, and message boards.
- Must be able to interpret payer contract language
- Fully comprehend and decipher varying EOB (Explanation of Benefits)
- Fully comprehend insurance claim processing behavior
- Mathematics, balancing and reconciling skills
- Time intelligence skills, converting payer units to 15 mins increments
- Organizational skills and efficient time management skills
- Willing to modify plans and behavior when necessary to meet goals
- Must be able to establish priorities and a course of action for handling multiple tasks
- Must be able to maintain the normal standard of ethics, conduct and organization policies in job related activities
- Ability to satisfactorily perform other duties upon request by supervisor or dept head
In addition to our clinicians and supporting departments, our company is built around four cross functional teams (spanning operations, product, marketing, business development, etc.):
- Demand - Deliver top notch products and services to our growing number of patients. You’ll work with families to understand pain points and optimize the patient journey from first contact to start of care to offboarding.
- Supply - Own and manage the relationship with our clinical practitioners. You are responsible for the growth of our clinician ecosystem by attracting, recruiting, and retaining high quality autism care providers.
- Platform - Build tools and provide services to optimize and improve the delivery of clinical care. You’ll help match the right provider with the right family, coordinate clinical care, and develop digital therapeutics products.
- Quality - Improve the quality of care delivered to our patients. You’ll ensure that we provide strong clinical outcomes, develop training platforms to level up our providers, and maintain compliance with a variety of payor and regulatory requirements.
At Sprout, we are a globally distributed team with many of our team members located in the following cities: San Francisco, New York, Los Angeles, Toronto, Montreal, and Kyiv. While everyone currently works remotely, we envision a future that balances face to face collaboration with a remote friendly environment.
What We Believe:
- Patients first, everything else second: We put our patients first, always. No decision is made at Sprout without considering the value it would bring to our families.
- Think and act like an owner: We think of ourselves as not just employees but part owners. We understand that when Sprout thrives, we all thrive.
- Candor and respect: We can't achieve greatness without ever disagreeing. We need to have healthy debates to ensure that we're making the right decisions.
- Never settle for less: We don't settle for anything less than excellence. We're relentlessly committed to delivering the best care to our patients and always strive to do better by them.
The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required for the position.
Sprout Therapy is an equal opportunity employer that is committed to providing all employees with a work environment free of discrimination and harassment. We celebrate diversity and welcome applicants from every background and life experience.