Manager of Payor Relations

Manager Of Payer Relations

The Manager of Payer Relations is responsible for developing and executing the organization's 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

• 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.
• 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.
• 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.
• 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.
• 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

• Bachelor's 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

• Master's 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 an Equal Opportunity 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.