Manager, Payor Relations

Adaptive Home Health, LLC; Houston (TX); On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

401(k) + 401(k) matching program

Health, dental, vision, and life insur

Paid time off

Job summary

Adaptive Home Health, LLC in Houston is seeking a Payer Relations Manager to own relationships with commercial and government health plans and secure workable contracts. You will work with cross-functional teams to ensure access and timely payment.

You will collaborate with revenue cycle, finance, credentialing, clinical operations, and legal to improve payer performance, drive renewals, and reduce denials and underpayments.

Qualifications

• Bachelor's degree or equivalent experience in healthcare administration, business, finance or related field.
• 3+ years in payer relations, managed care contracting, revenue cycle, or reimbursement analysis.
• Experience with analyzing financial data and turning it into actionable insights.

Responsibilities

• Serve as the primary relationship owner for assigned health plans and act as escalation contact.
• Support contract negotiations and renewals with analysis of rates, terms, volume, and financial impact.
• Coordinate with revenue cycle to resolve denials, underpayments, and authorization issues and drive process improvements.

Skills

Negotiation

Relationship management

Project management

Financial data analysis

Education

Bachelor's degree in healthcare administration, business, or finance

Tools

Contract management tools

Job description

We are fixing US healthcare by building an AI-native physical care platform, starting with home health.

Home health is a $140B industry with less than $10B in EBITDA — 40% of revenue is spent on pure administrative waste. We automate this work with AI, creating a fundamentally different cost structure compared to incumbents. This lets us rapidly take market share by serving the 30% of patients who go untreated today.

By reshaping the cost structure of this industry, we unlock its growth.

We've built one of the best AI teams in the world (from Character AI, Scale, Palantir, Citadel, Jane Street) and paired them with a team of healthcare veterans to build a new type of healthcare company: one that delivers care at the speed of an AI company.

Our physical care platform already operates with 30pp higher gross margins than traditional home health providers. With our AI advantage, we pay nurses more, remove their admin burden, and unlock the scale economics that have been missing from this fragmented industry. If we served this entire $140B market, instead of $10B in EBITDA, we'd drive $60B.

We're starting with home health, then expanding to all delivered care. Our mission is "any care, any where".

Fundamentally, our incentives are aligned with America. Every dollar in revenue we make is two dollars taken out of the healthcare system. If we succeed, so does US healthcare.

What You'll Do

The Payer Relations Manager owns the organization's relationships with commercial and government health plans. This role helps secure workable contracts, resolves issues that affect patient access or payment, and gives leadership a clear view of payer performance. You'll work closely with revenue cycle, finance, credentialing, clinical operations, and legal.

Key Responsibilities

• Serve as the primary relationship owner and escalation contact for assigned health plans
• Support contract negotiations and renewals with analysis of rates, terms, volume, and financial impact. Track renewal dates, notice deadlines, and rate changes.
• Partner with revenue cycle to resolve recurring denials, underpayments, payment delays, and authorization issues, and drive process changes that prevent them from recurring
• Monitor payer performance, including contract compliance, denial rates, AR aging, and escalation trends, and report findings and recommendations to leadership
• Evaluate network participation opportunities and payer changes that affect patient access or financial performance
• Coordinate with credentialing and enrollment on participation issues, and with legal and compliance on contract language and disputes
• Communicate material payer policy and contract changes to affected teams

Measures of success

Strong renewal outcomes, timely resolution of escalations, fewer recurring denials and underpayments, faster payments, and accurate payer performance reporting.

Basic Qualifications

• Bachelor's degree in healthcare administration, business, finance, or a related field, or equivalent experience
• 3+ years in payer relations, managed care contracting, revenue cycle, or reimbursement analysis, including direct work with health plans on contract, claims, or payment issues
• Working knowledge of reimbursement methods, payer contracts, claims workflows, and the drivers of denials and underpayments
• Ability to analyze financial and operational data and turn it into clear, practical recommendations
• Strong negotiation, relationship management, and project management skills

Preferred Qualifications

• Direct experience negotiating or implementing commercial and Medicare Advantage contracts
• Familiarity with credentialing, enrollment, and value-based payment arrangements
• Experience with contract management, claims analysis, or revenue cycle reporting tools

What We Offer

• 401(k) + 401(k) matching program
• Health, dental, vision, and life insurance
• Paid time off
• Opportunity for growth in a fast-growing company
• Collaborative team valuing innovation and problem-solving