Manager, Payor Relations

Adaptive Home Health, LLC; United States; Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

Competitive salary

Equity compensation

Health insurance

Dental

Commuter benefits

401(k) retirement plan with employer"s

Flexible time off

Growth opportunities

Collaborative team

Job summary

Adaptive Home Health, LLC is seeking a Payer Relations Manager to lead strategic relationships with commercial and government plans. You will secure workable contracts, address access or payment issues, and provide leadership with clear payer performance metrics.

As part of the team, you will collaborate with revenue cycle, finance, credentialing, clinical operations, and legal to optimize reimbursements and contract terms, driving healthier margins.

Qualifications

• Bachelor’s degree in healthcare administration, business, finance, or related field.
• 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.

Responsibilities

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

Skills

Negotiation

Relationship management

Project management

Analytical thinking

Education

Bachelor’s degree in healthcare administration, business, finance, or related field

Tools

Revenue cycle software

Job description

About Us

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

• Competitive salary and equity compensation




• Comprehensive health insurance, dental, and commuter benefits




• 401(k) retirement plan with employer contribution




• Flexible time off policy — we expect most employees to take at least 3 weeks of vacation per year




• Opportunity for growth in a fast-growing company




• Collaborative team valuing innovation and problem-solving