Manager of Payor Relations

Position Summary

The Manager of Payer Relations is responsible for developing and executing the organizations payer strategy while overseeing the full lifecycle of payer and related contracts. This role serves as the primary liaison with commercial and government payers leading contract negotiations optimizing reimbursement and ensuring regulatory compliance and revenue integrity. Through close collaboration with finance revenue cycle legal compliance and clinical teams the position supports organizational growth service expansion and value-based care initiatives. The role provides data-driven insights performance reporting and strategic recommendations to executive leadership to maximize financial performance and strengthen payer partnerships.

Key Responsibilities

Payer Strategy & Relationship Management

• Develop and execute a comprehensive payer strategy aligned with organizational growth service expansion and financial objectives.
• Establish maintain and strengthen strategic relationships with commercial payers Medicare Advantage plans Medicaid managed care organizations and other third-party payers.
• Serve as the primary point of contact for all payer and contract-related matters including inquiries escalations and performance discussions.
• Represent the organization in payer meetings joint operating committees and industry forums as appropriate.
• Provide payer intelligence and strategic recommendations to executive leadership to support informed decision-making.

Contracting Negotiation & Lifecycle Management

• Lead the drafting review negotiation execution renewal amendment and administration of all payer and vendor contracts.
• Negotiate reimbursement rates contract terms performance incentives value-based arrangements and risk-sharing models to optimize financial and operational outcomes.
• Interpret and analyze contract language to ensure regulatory compliance accurate billing and revenue cycle efficiency.
• Monitor contract performance and compliance; manage renewals extensions amendments and close-outs.
• Develop implement and maintain contract-related policies procedures and a contract lifecycle management platform.
• Manage all contract-related documentation correspondence and records to ensure accuracy accessibility and audit readiness.
• Communicate contract obligations risks and changes clearly and timely to internal and external stakeholders.

Reimbursement Optimization & Revenue Integrity

• Monitor payer reimbursement trends denial patterns underpayments and payment variances.
• Identify and proactively address reimbursement risks payer policy changes and contract performance issues.
• Develop and execute action plans to resolve underpayments denials disputes and non-compliance.
• Partner with revenue cycle finance and clinical teams to ensure accurate coding documentation and billing aligned with payer requirements.

Cross-Functional Collaboration & Organizational Support

• Collaborate closely with revenue cycle finance legal compliance clinical operations and leadership teams to align payer and contract strategies with organizational priorities.
• Support new service launches market expansions and value-based care initiatives through payer strategy and contract readiness.
• Provide subject matter expertise and issue resolution related to payer and contract matters across the organization.

Reporting Analytics & Market Intelligence

• Track analyze and report on key payer and contract performance metrics including reimbursement rates denial trends contract compliance and net revenue impact.
• Prepare regular reports and presentations summarizing payer performance risks and opportunities.
• Stay current on healthcare reimbursement trends regulatory developments and payer policy changes affecting the organization.

Qualifications

Required Qualifications

• Bachelors degree in healthcare administration business finance or a related field.
• 5 years of experience in payer relations managed care contracting reimbursement or revenue cycle management.
• Demonstrated experience negotiating payer contracts with commercial Medicare Advantage and/or Medicaid payers.
• Strong understanding of healthcare reimbursement methodologies managed care concepts and payer policies.
• Excellent communication negotiation and relationship management skills.

Preferred Qualifications

• Masters degree in healthcare administration business administration or a related field.
• Experience with value-based care arrangements and alternative payment models.
• Knowledge of regulatory requirements related to Medicare Medicaid and managed care contracting.

Skills & Competencies

• Strategic thinking and analytical capabilities
• Strong negotiation and problem-solving skills
• Ability to interpret complex contract language and reimbursement data
• Collaborative leadership style with the ability to influence cross-functional teams
• High level of professionalism discretion and accountability

Benefits include but are not limited to:

• health
• dental
• vision
• 401K plus match
• incentive program
• life insurance
• paid time off
• paid holidays
• long-term disability
• short-term disability
• free parking
• volunteer pay
• green initiatives

We are on the Green Line!

We are anEqualOpportunity Employer and prohibit discrimination/harassment without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.