Payor Relations Manager
Payor Relations Manager
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
As a Payor Relations Manager within our Dental Service Organization (DSO) you will act a key liaison between our multisite dental practices and thirdparty payors. This role is responsible for maintaining strong payor relationships resolving midlevel insurance issues and supporting compliance through complaint management and quality audit preparation.
Responsibilities
- Payor Guidelines & Relations:
- Maintain payor Provider Guides ensuring accurate fee schedules and terms across all locations.
- Engage with payor account managers initiating regular checkins to review network performance and resolve outstanding issues.
- Complaint Resolution:
- Lead the resolution of escalated payor complaints including those related to patient grievances service coverage disputes and claim denials.
- Coordinate with clinical and billing teams to gather supporting documentation and formulate compliant timely responses.
- Maintain a centralized complaint tracking system to monitor trends root causes and resolution outcomes.
- Ensure responses to formal complaints and regulatory inquiries are thorough timely and aligned with contractual and legal standards.
- Quality Management (QM) & Audit Support:
- Coordinate internal responses to payorinitiated audits quality assurance reviews and documentation requests.
- Work closely with compliance and clinical leadership to ensure accurate complete and auditready patient records.
- Monitor payor quality metrics and ensure clinical documentation and billing practices align with payor QM requirements.
- Serve as the liaison for QM corrective action plans when required by payors ensuring timely followthrough and implementation.
- Data Analysis & Tracking:
- Track payor performance metrics including denial rates complaint trends and appeal outcomes.
- Develop and present actionable reports to senior leadership to inform strategic decisionmaking.
- Training & Communication:
- Educate internal teams on payor policy changes documentation requirements and best practices for complaint and audit readiness.
- Partner with compliance and operations to continuously refine internal workflows based on audit outcomes and complaint trends.
Qualifications
35 years of experience in dental or healthcare payor relations contract negotiation and/or claims resolution within a DSO or insurance environment.
Strong working knowledge of CDT codes dental billing and documentation standards.
Experience handling formal payor complaints appeals and QM audits.
Skills
Exceptional communication documentation and negotiation skills.
Analytical mindset with attention to compliance and audit detail.
Ability to manage sensitive complaint and audit data with discretion.
Proficiency in dental software systems and Microsoft Office particularly Excel and SharePoint.
Work Environment
On Site; occasional travel to practice sites or payor meetings.
Required Experience:
Manager
Employment Type
Full-Time
