Full-Time Payer Relations Manager

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

Primary Responsibilities:

1. Serve as primary point of contact for payer representatives addressing issues related to enrollment, underpayments, and billing challenges.
2. Develop and maintain productive relationships with key stakeholders at health plans to ensure open communication and timely issue resolution.
3. Facilitate regular meetings with payers to review performance metrics, address concerns, and discuss improvement opportunities.
4. Monitor and manage ongoing payer issues (enrollment worklists, claim denials, underpayments).
5. Escalate unresolved or recurring issues to payer representatives and internal leadership.
6. Collaborate with internal teams to analyze root causes of payer-related issues and implement corrective actions.
7. Provide market leadership and payer contracting teams with regular updates on national payer trends.
8. Prepare detailed reports on payer performance, industry developments, and contract compliance.
9. Act as liaison between internal teams and payer contracting teams to align strategies.
10. Work closely with operational teams (billing, revenue integrity, contracting) to ensure alignment on payer strategies.
11. Participate in cross-functional meetings to share insights on payer performance and support strategic planning.
12. Support payer contracting teams in negotiations by providing data-driven insights on payer behavior.
13. Build rapport and maintain strong relationships with key stakeholders at health plans.
14. Advocate for the organization’s interests while working with payers to identify mutually beneficial solutions.
15. Stay informed about payer priorities to anticipate and address potential issues.
16. Track and report on payer performance metrics (claim processing times, underpayment trends, denial rates).
17. Provide actionable insights to leadership based on data analysis.
18. Ensure compliance with payer contracts.

Requirements:

• Bachelor's degree in healthcare administration, business, or related field (Master's preferred).
• Strong experience in payer relations and RCM.
• Strong understanding of payer contracting, billing processes, and healthcare regulations.
• Proven ability to build relationships with external stakeholders.
• Excellent problem-solving and analytical skills.
• Exceptional communication and interpersonal skills.
• Advanced Microsoft Excel skills (VLOOKUP, sorting/filtering/formatting, pivot tables, formulas).
• Experience with athenaNet and Cognizant TriZetto products preferred.

Salary: $70,000 - $80,000 base pay (plus bonus and benefits)

Remote Work Requirements: 5 Mbps Download and 3 Mbps Upload speed minimum.

Equal Opportunity Employer: Privia Health values diversity and encourages people from all backgrounds to apply.

What is the last date for applying to the job?

Which countries are accepted for this remote job?