Manager of Payor Relations
Objective and Purpose: The Manager of Payor Relations is responsible for developing and managing relationships with insurance payors to ensure favorable reimbursement rates, efficient claims processing, and overall network optimization for supported specialty practices. This role focuses on negotiating competitive fee schedules, analyzing existing agreements for improvement opportunities, and collaborating with Revenue Cycle Management, Operations, and Clinical Leadership to address payor-related challenges. By staying informed on industry trends, regulatory changes, and evolving reimbursement models, the Manager of Payor Relations proactively adjusts strategies to maintain compliance and maximize revenue opportunities. Serving as a liaison between payors and supported practices, this role provides guidance on contract terms, credentialing, and claims escalation while aligning payor strategies with Specialty1 Partners’ commitment to specialist-driven patient care and financial sustainability. Primary Responsibilities :
- Develop and maintain relationships with insurance payors to negotiate favorable contract terms and reimbursement rates.
- Analyze existing payor agreements to identify opportunities for rate improvements, network expansion, and contract optimization.
- Collaborate with Revenue Cycle Management, Operations, and Clinical Leadership to address payor-related challenges and improve billing efficiencies.
- Monitor industry trends, regulatory changes, and evolving reimbursement models to adjust strategies proactively and ensure compliance.
- Serve as a liaison between payors and supported practices, providing guidance on contract terms, credentialing, claims escalation, and dispute resolution.
- Implement strategies to optimize reimbursement processes, minimize denials and underpayments, and improve cash flow for supported practices.
- Develop and execute initiatives to enhance insurance participation strategies, including in-network and out-of-network positioning.
- Lead contract negotiations and renegotiations to secure competitive rates while balancing cost and quality of care for patients.
- Partner with legal and compliance teams to ensure all agreements meet state and federal regulations.
- Provide ongoing education and support to internal stakeholders on payor policies, reimbursement trends, and contract requirements.
- Track and analyze key performance indicators (KPIs) related to payor performance, reimbursement trends, and contract effectiveness.
- Work closely with credentialing teams to streamline provider enrollment and payor onboarding processes.
- Identify opportunities for strategic payor partnerships to enhance Specialty1 Partners’ market positioning and competitive advantage.
Requirements :
- Bachelor’s degree in business, healthcare administration, finance, or a related field (Master’s preferred).
- Minimum of 5 years of experience in payor relations, managed care contracting, revenue cycle management, or healthcare reimbursement.
- Experience working with specialty dental or medical practices is highly preferred.
- In-depth knowledge of payor contracting, reimbursement methodologies, and healthcare regulations, including Medicare, Medicaid, and commercial payors.
- Strong understanding of fee schedule negotiations, claims adjudication, and dispute resolution processes.
- Familiarity with revenue cycle operations, including billing, coding, credentialing, and collections.
- Strong negotiation and contract management skills with a proven track record of securing competitive payor agreements.
- Ability to analyze complex data, identify trends, and make strategic recommendations to optimize reimbursement.
- Excellent communication and interpersonal skills to build and maintain strong relationships with payors, internal stakeholders, and supported practices.
- Problem-solving and conflict resolution skills to address claims disputes and reimbursement issues effectively.
- Highly organized, detail-oriented, and capable of managing multiple contracts and projects simultaneously.
- Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and healthcare-related software (EHR, practice management, and claims processing systems).
- Experience with contract management systems and data analytics tools is a plus.
- Ability to travel as needed to meet with payors, attend industry conferences, or visit supported practices.
- Strong business acumen and ability to align payor strategies with overall financial and operational goals.
Benefits :
- BCBS Medical & Dental insurance Options
- VSP Vision Coverage
- Complimentary Life Insurance Policy (employee only)<
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