Full-Time Payer Relations Manager

Payer Relations Manager will manage and optimize relationships with health plans for effective revenue cycle operations.

Primary Responsibilities:

1. Payer Relationship Management:
• Serve as primary contact for payer representatives to resolve enrollment, underpayment, and billing issues.
• Develop and maintain productive relationships with key health plan stakeholders.
• Facilitate regular meetings with payers to review performance, address concerns, and discuss improvements.

1. Issue Escalation and Resolution:
• Monitor payer issues (enrollment worklists, claim denials, underpayments).
• Escalate unresolved issues to payer representatives and internal leadership.
• Collaborate with internal teams to analyze and resolve payer issues.

1. National Payer Communication:
• Provide market leadership and payer contracting teams with updates on national payer trends and changes.
• Prepare reports on payer performance, industry developments, and contract compliance.
• Act as a liaison between internal and payer contracting teams to align strategies.

1. Collaboration and Coordination:
• Collaborate with operational teams (billing, revenue integrity, contracting) for alignment on strategies.
• Participate in cross-functional meetings to share insights on payer performance.
• Support payer contracting teams with data-driven insights on payer behavior.

1. Stakeholder Engagement:
• Build strong relationships with key health plan stakeholders, fostering trust and collaboration.
• Advocate for organizational interests while finding mutually beneficial solutions.
• Stay informed about payer priorities to address potential issues.

Performance Monitoring and Reporting:

• Track and report on payer performance (claim processing, underpayments, denial rates).
• Provide actionable insights to leadership.
• Ensure compliance with payer contracts and organizational goals.

Qualifications:

• Bachelor's degree in healthcare administration, business, or related field (Master's preferred).
• 5+ years of experience in payer relations, revenue cycle, or healthcare operations.
• Strong understanding of payer contracting, billing, and regulations.
• Proven ability to build and maintain relationships.
• Excellent problem-solving, analytical, communication, and interpersonal skills.
• Advanced Microsoft Excel skills (VLOOKUP, formulas, pivot tables).
• Experience using athenaNet and Cognizant TriZetto products.

Salary: $70,000 - $80,000 base + 15% annual bonus potential.

Remote Requirements (for remote workers): Minimum 5 Mbps download and 3 Mbps upload speed. Expense reimbursement for remote workers available.

Equal Opportunity Employer: Privia Health values diverse perspectives. We are committed to creating a welcoming environment for all employees.

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