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 address enrollment, underpayment, and billing issues. Develop and maintain productive relationships with key stakeholders to ensure timely issue resolution. Facilitate regular meetings to review performance, address concerns, and discuss improvements.
2. Issue Escalation and Resolution: Monitor ongoing payer issues (enrollment worklists, claim denials, underpayments, etc.). Escalate unresolved or recurring issues to payer representatives and leadership. Collaborate on root cause analysis and corrective actions.
3. National Payer Communication: Provide market leadership and payer contracting teams with updates on national payer trends, challenges, and operational impacts. Prepare and deliver detailed reports on performance, industry developments, and contract compliance. Act as liaison between internal and payer contracting teams.
4. Collaboration and Coordination: Align with operational teams (billing, revenue integrity, contracting) on payer strategies and issue resolution. Participate in cross-functional meetings, share insights, and support strategic planning. Provide data-driven insights to support payer contracting negotiations.
5. Stakeholder Engagement: Build strong relationships with key stakeholders at health plans, fostering trust and collaboration. Advocate for the organization's interests while identifying mutually beneficial solutions. Stay informed on payer priorities to proactively address potential issues.
6. Performance Monitoring and Reporting: Track and report on payer performance metrics (claim processing times, underpayment trends, denial rates). Provide actionable insights to leadership. Ensure compliance with payer contracts and organizational goals.

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

Salary Range: $70,000 - $80,000 base salary, plus bonus and benefits. Bonus targeted at 15% annually. Base pay depends on experience, education, and location.

Technical Requirements (Remote Only): Minimum internet speed: 5 Mbps download and 3 Mbps upload. Online speed tests recommended. Internet expense reimbursement for remote employees.

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