Position SummaryThe Senior Lead Provider Network Onboarding and Integration will play a critical role in supporting the expansion of the TPA business by leading the onboarding, integration, and operational enablement of national, regional, direct contract provider networks and network aggregators. This role is responsible for establishing and maintaining network connectivity, ensuring seamless integration with internal claims platforms, and enabling TPA clients to leverage network services effectively.
The individual will serve as the bridge between network providers, technology teams, and operations (Claims Adjudications, Payments, and Customer Care), ensuring that all network capabilities are fully operational and aligned with client requirements.
Position Responsibilities:- Lead onboarding of new national and regional healthcare networks as well as DPCs and COEs as part of TPA business growth strategy.
- Demonstrate strong ability to maintain a big-picture focus while balancing strategic and tactical priorities.
- Coordinate with both internal and external network stakeholders to establish contractual, operational, and technical readiness.
- Ensure network configurations align with business goals and client-specific requirements.
- Design and oversee integration of network services into TPA eco systems using API and file-based approaches.
- Enable core transactions between Judi Health and the network including, Claims, submission and adjudication workflows, Eligibility and benefits verification, Prior authorization processing, Provider data exchange and updates.
- Establish protocols for Member Identification cards and logos.
- Collaborate with Technology stakeholders to ensure secure, accurate, and scalable integrations in line with the industry as well as cybersecurity rigors.
- Troubleshoot and resolve integration issues, ensuring minimal disruption to operations.
- Ensure appropriate system configurations, access controls, and reporting capabilities are in place in terms of third-party systems use.
- Support go-live activities, including testing, validation, and transition to steady-state operations.
- Serve as a subject matter expert (SME) for network integration capabilities during client onboarding and implementations.
Required Qualifications:- Bachelor's degree in healthcare administration, Information Systems, Business, or a related field.
- Minimum of 5 years of experience in the healthcare network or managed care space, preferably within a TPA, payer, or network organization.
- Strong familiarity and hands-on experience with healthcare data exchange standards (EDI transactions such as 837, 835, 270/271, 278).
- Experience with API-based integrations and file-based data exchange mechanisms.
Preferred Qualifications- Familiarity with claims platforms and provider focused healthcare technology ecosystems.
- Strong understanding of provider data management and network configuration.
- Experience working cross-functionally with operations, IT, and external vendors.
- Excellent problem-solving, communication, and stakeholder management skills.
New York, NY Salary Range
$174,800-$218,500 USD
Denver, CO Salary Range
$160,000-$200,000 USD
Charlotte, NC Salary Range
$145,600-$182,000 USD
All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
