Payer Relations Manager
Prism, Elkin, NC, United States
Payer Relations Manager
The Payer Relations Manager provides all operational oversight and leadership to payer contracting, credentialing, reimbursement support, and communications, ensuring team efficiency, regulatory compliance, and alignment with organizational goals. This role collaborates cross‑functionally and with internal and external stakeholders to resolve complex issues, improve revenue performance, and strengthen long‑term relationships.
Responsibilities
Oversees contract management, credentialing, and payer support functions to ensure accuracy, accountability, and productivity, while directing the execution, documentation, and ongoing maintenance of payer contracts to uphold compliance and support timely renewals in collaboration with leadership.
Analyzes payer performance data (e.g., denial rates, payment timelines, contract compliance), models payer contracts to forecast financial impacts while leveraging knowledge of claims adjudication and revenue cycle metrics to support strategic decision‑making.
Delegates resolution of payer‑related escalations, including claim denials, authorization barriers, payment disputes, and operational bottlenecks, guiding team members and engaging internal and external stakeholders in a timely manner.
Leads payer credentialing and enrollment processes, ensuring timely submission, tracking, and follow‑up of applications in alignment with regulatory standards and payer‑specific requirements.
Demonstrates deep expertise in contracting platforms and systems, overseeing their implementation, optimization, and daily use to ensure accurate contract management, streamlined workflows, and alignment with organizational goals.
Evaluates payer performance metrics, analyzing trends related to reimbursement, contract compliance, and operational efficiency, and prepares regular performance reports with insights and recommendations for leadership.
Leads the development and execution of strategic initiatives to build and maintain strong relationships with key insurance payers and industry stakeholders including associations, providers, and advocacy groups, to align contracting efforts with organizational goals, drive referral growth, influence policy, and collaboratively address regulatory and payer‑related challenges through active engagement in industry forums and initiatives.
Drives timely and accurate payer policy changes and operational updates by coordinating cross‑functional communication, updating protocols, ensuring staff training, and supporting compliance efforts to maintain seamless care delivery.
Manages team leaders’ performance by conducting regular reviews, setting clear development goals, and delivering constructive feedback to support individual growth. Identifies training needs and partners with Training & Development to implement professional development programs aligned with team and organizational objectives.
Promotes a culture of continuous learning and professional development, providing performance feedback, mentoring staff, facilitating team training, and ensuring the team is equipped with the knowledge and tools to meet evolving organizational and payer demands.
Adheres to company policies and procedures regarding employment, safety, and compliance. Resolve any area of non‑compliance immediately.
Performs other duties as requested by executive leadership/management.
Qualifications
Bachelor’s degree in healthcare administration, business, finance, public health, or a related field, or an equivalent combination of education and experience.
Three years or more of experience in payer relations, negotiating payer contracts, resolving claims/payment issues, managed care contracting, provider network management, or revenue cycle operations, and prior experience with health plans or third‑party administrators (TPAs) is preferred.
Ability to work independently, communicate proactively, manage multiple projects and prioritize daily tasks while handling critical deadlines.
Ability to develop and utilize cross‑functional relationships to facilitate the achievement of work goals and objectives.
Excellent overall oral and written communication skills.
Attention to detail in composing, typing and proofing materials, establishing priorities and meeting deadlines.
Must be able to work in a fast‑paced environment with demonstrated ability to juggle multiple competing tasks and demands, and professionally interact and communicate with individuals at all levels of the organization.
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
This position is currently accepting applications.
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Responsibilities
Oversees contract management, credentialing, and payer support functions to ensure accuracy, accountability, and productivity, while directing the execution, documentation, and ongoing maintenance of payer contracts to uphold compliance and support timely renewals in collaboration with leadership.
Analyzes payer performance data (e.g., denial rates, payment timelines, contract compliance), models payer contracts to forecast financial impacts while leveraging knowledge of claims adjudication and revenue cycle metrics to support strategic decision‑making.
Delegates resolution of payer‑related escalations, including claim denials, authorization barriers, payment disputes, and operational bottlenecks, guiding team members and engaging internal and external stakeholders in a timely manner.
Leads payer credentialing and enrollment processes, ensuring timely submission, tracking, and follow‑up of applications in alignment with regulatory standards and payer‑specific requirements.
Demonstrates deep expertise in contracting platforms and systems, overseeing their implementation, optimization, and daily use to ensure accurate contract management, streamlined workflows, and alignment with organizational goals.
Evaluates payer performance metrics, analyzing trends related to reimbursement, contract compliance, and operational efficiency, and prepares regular performance reports with insights and recommendations for leadership.
Leads the development and execution of strategic initiatives to build and maintain strong relationships with key insurance payers and industry stakeholders including associations, providers, and advocacy groups, to align contracting efforts with organizational goals, drive referral growth, influence policy, and collaboratively address regulatory and payer‑related challenges through active engagement in industry forums and initiatives.
Drives timely and accurate payer policy changes and operational updates by coordinating cross‑functional communication, updating protocols, ensuring staff training, and supporting compliance efforts to maintain seamless care delivery.
Manages team leaders’ performance by conducting regular reviews, setting clear development goals, and delivering constructive feedback to support individual growth. Identifies training needs and partners with Training & Development to implement professional development programs aligned with team and organizational objectives.
Promotes a culture of continuous learning and professional development, providing performance feedback, mentoring staff, facilitating team training, and ensuring the team is equipped with the knowledge and tools to meet evolving organizational and payer demands.
Adheres to company policies and procedures regarding employment, safety, and compliance. Resolve any area of non‑compliance immediately.
Performs other duties as requested by executive leadership/management.
Qualifications
Bachelor’s degree in healthcare administration, business, finance, public health, or a related field, or an equivalent combination of education and experience.
Three years or more of experience in payer relations, negotiating payer contracts, resolving claims/payment issues, managed care contracting, provider network management, or revenue cycle operations, and prior experience with health plans or third‑party administrators (TPAs) is preferred.
Ability to work independently, communicate proactively, manage multiple projects and prioritize daily tasks while handling critical deadlines.
Ability to develop and utilize cross‑functional relationships to facilitate the achievement of work goals and objectives.
Excellent overall oral and written communication skills.
Attention to detail in composing, typing and proofing materials, establishing priorities and meeting deadlines.
Must be able to work in a fast‑paced environment with demonstrated ability to juggle multiple competing tasks and demands, and professionally interact and communicate with individuals at all levels of the organization.
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
This position is currently accepting applications.
#J-18808-Ljbffr