Payer Relations Manager

The Payer Relations Manager will be responsible for managing and optimizing relationships with health plans to ensure effective and efficient revenue cycle operations. This role involves addressing ongoing payerrelated issues including enrollment worklists underpayment challenges and billing concerns while maintaining open lines of communication with market leadership and payer contracting teams regarding national payer trends. Additionally the Payer Relations Manager will build strong relationships with key stakeholders at health plans to promote collaboration and resolve systemic issues.

Primary Job Duties:

1. Payer Relationship Management:

   • Serve as the primary point of contact for payer representatives to address and resolve issues related to enrollment underpayments and billing challenges.

   • Develop and maintain productive relationships with key stakeholders at health plans to ensure open communication and timely issue resolution.

   • Facilitate regular meetings with payers to review performance metrics address concerns and discuss opportunities for improvement.

2. Issue Escalation and Resolution:

   • Monitor and manage ongoing payer issues including enrollment worklists claim denials underpayments and other billing challenges.

   • Escalate unresolved or recurring issues to payer representatives and internal leadership as needed.

   • Collaborate with internal teams to analyze root causes of payerrelated issues and implement corrective actions.

3. National Payer Communication:

   • Provide market leadership and payer contracting teams with regular updates on national payer trends challenges and changes that may impact operations.

   • Prepare and deliver detailed reports on payer performance industry developments and contract compliance.

   • Act as a liaison between internal teams and payer contracting teams to align strategies and address systemic challenges.

4. Collaboration and Coordination:

   • Work closely with operational teams including billing revenue integrity and contracting to ensure alignment on payer strategies and issue resolution.

   • Participate in crossfunctional meetings to share insights on payer performance and support strategic planning.

   • Support payer contracting teams in negotiations by providing datadriven insights on payer behavior and performance.

5. Stakeholder Engagement:

   • Build rapport and maintain strong relationships with key stakeholders at health plans fostering trust and collaboration.

   • Advocate for the organizations interests while working with payers to identify mutually beneficial solutions.

   • Stay informed about payer priorities and initiatives to better anticipate and address potential issues.

6. Performance Monitoring and Reporting:

   • Track and report on payer performance metrics including claim processing times underpayment trends and denial rates.

   • Provide actionable insights to leadership based on data analysis and trends.

   • Ensure compliance with payer contracts and organizational goals.

Qualifications :

• Bachelors degree in healthcare administration business or a related field (Masters degree preferred).

• Strong experience in payer relations and RCM required .

• Strong understanding of payer contracting billing processes and healthcare regulations.

• Proven ability to build and maintain relationships with external stakeholders including health plans.

• Excellent problemsolving and analytical skills with the ability to identify trends and develop strategic solutions.

• Exceptional communication and interpersonal skills with experience in presenting to leadership.

• Advanced Microsoft Excel skills strongly preferred  (ex: VLOOKUP sort/filtering/formatting pivot table and formulas) 

• Experience using athenaNet and Cognizant TriZetto products preferred 

The salary range for this role is $70000 to $80000 in base pay and exclusive of any bonus or benefits (medical dental vision life and pet insurance 401K paid time off and other wellness programs). This role is also eligible for an annual bonus targeted at 15% based on performance in the role and restricted stock units. The base pay offered will be determined based on relevant factors such as experience education and geographic location.

Additional Information :

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (for remote workers only not applicable for onsite/in office work):

In order to successfully work remotely supporting our patients and providers we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age color national origin physical or mental (dis)ability race religion gender sex gender identity and/or expression marital status veteran status or any other characteristic protected by federal state or local law.  

Remote Work :

Yes

Employment Type :

Fulltime