Specialty1 Partners
Manager of Payor Relations - Dental
Specialty1 Partners, Houston, Texas, United States, 77246
Position Overview
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 specialty practices. This role focuses on negotiating fee schedules, analyzing agreements, and collaborating with Revenue Cycle Management, Operations, and Clinical Leadership to address payor‐related challenges.
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 market positioning and competitive advantage.
Qualifications
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 and internal stakeholders.
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.
Experience with contract management systems and data analytics tools is a plus.
Ability to travel as needed to meet with payors and attend industry conferences.
Strong business acumen and ability to align payor strategies with overall financial and operational goals.
Compensation Base Salary Range: $90,000 - $100,000 USD
EEO Statement Specialty1 Partners and its affiliates are equal‑opportunity employers who recognize the value of a diverse workforce. All suitably qualified applicants will receive consideration for employment based on objective criteria and without regard to race, color, age, religion, gender, national origin, disability, sexual orientation, gender identity, protected veteran status, or other characteristics in accordance with the relevant governing laws.
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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 market positioning and competitive advantage.
Qualifications
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 and internal stakeholders.
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.
Experience with contract management systems and data analytics tools is a plus.
Ability to travel as needed to meet with payors and attend industry conferences.
Strong business acumen and ability to align payor strategies with overall financial and operational goals.
Compensation Base Salary Range: $90,000 - $100,000 USD
EEO Statement Specialty1 Partners and its affiliates are equal‑opportunity employers who recognize the value of a diverse workforce. All suitably qualified applicants will receive consideration for employment based on objective criteria and without regard to race, color, age, religion, gender, national origin, disability, sexual orientation, gender identity, protected veteran status, or other characteristics in accordance with the relevant governing laws.
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