Plan Manager

JOB SUMMARY

To perform this job successfully an individual must be able to perform each essential job duty satisfactorily. The Plan Manager oversees payer plan participation reimbursement accuracy fee schedule maintenance and underpayment recovery across the organization. This role partners cross-functionally to optimize payer reimbursement maintain accurate payer records identify financial opportunities and support strategic payer initiatives.

ESSENTIAL JOB RESPONSIBILITIES

• Manage the payer plan lifecycle including participation changes implementation maintenance and termination.
• Audit payer reimbursement against contracted fee schedules and applicable reimbursement methodologies.
• Identify reimbursement discrepancies and underpayments and coordinate recovery efforts with Revenue Cycle and other stakeholders.
• Maintain accurate payer plan inventories participation records and reimbursement documentation.
• Analyze payer performance reimbursement trends and financial opportunities to improve reimbursement outcomes.
• Partner with Credentialing Revenue Cycle Operations and Finance to resolve payer-related issues and improve processes.
• Support payer contract administration fee schedule updates and implementation of reimbursement changes.

OTHER JOB RESPONSIBILITIES

• Participate in special projects acquisitions implementations integrations and operational initiatives.
• Assist with payer-related escalations and issue resolution.
• Support departmental objectives and organizational strategic initiatives.
• Perform other duties as assigned.

REQUIRED EDUCATION AND EXPERIENCE

• Bachelors degree in healthcare administration Business Administration Finance Accounting Revenue Cycle Management or a related field preferred.
• Minimum three (3) years of experience in payer relations managed care healthcare contracting credentialing revenue cycle management or related healthcare administration.
• Experience auditing payer reimbursement against contractual fee schedules and reimbursement methodologies required.
• Experience supporting payer enrollment participation management reimbursement analysis or contract administration preferred.
• Experience working within a multi-site healthcare or dental organization preferably a Dental Support Organization (DSO) preferred.
• Experience using healthcare reporting systems practice management platforms and data analytics tools preferred.

QUALIFICATIONS

• Knowledge of payer contracts reimbursement methodologies fee schedules claims adjudication and network participation requirements.
• Understanding of healthcare revenue cycle operations payer enrollment processes and credentialing workflows.
• Ability to interpret contracts amendments reimbursement schedules and payer policy documentation.
• Proficiency in Microsoft Excel including formulas pivot tables lookups and data analysis.
• Strong analytical organizational and problem-solving skills.
• Ability to manage multiple projects priorities deadlines and stakeholder expectations.
• Strong verbal written presentation and interpersonal communication skills.
• Ability to prepare reports dashboards and financial analyses for leadership.
• Demonstrated attention to detail and commitment to data accuracy.
• Ability to maintain confidentiality when handling proprietary business and reimbursement information.
• Strong project management and process improvement capabilities.
• Experience with Ascend or similar practice management systems preferred.

PHYSICAL REQUIREMENTS

• Frequently remains in a stationary position while performing computer-based work.
• Frequently operates a computer telephone and other standard office equipment.
• Occasionally moves about offices and meeting locations.
• Travel up to 25% may be required.
• Frequently communicates with employees leaders providers and payer representatives.
• Frequently reviews electronic and printed documentation.

The above statements are intended to provide a general overview and level of work being performed by most people assigned to this job. They are not intended to be a list of all responsibilities duties and requirements. Additional duties can be assigned as determined.

Elite Dental Partners is an Equal Opportunity Employer. We support a diverse workforce.

We take great pride in helping our communities be healthier feel better and smile with confidence. Daily we are driven by our vision to provide an elite patient experience tailored to their needs to receive the best care possible.

Not only do our team members find it rewarding to help patients be healthier but they also enjoy being part of an organization that supports their growth. Our commitment to professional development and promoting internally when appropriate allows for tremendous career opportunities.