Payer Plan Optimization Lead

Elite Dental Partners; Chicago (IL); On-site; USD 85,000 - 95,000; Full time

Job summary

Elite Dental Partners is seeking a Plan Manager to oversee 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.

The role requires a Bachelor’s degree in a related field and 3+ years of payer relations or managed care experience.

Qualifications

• Bachelor’s degree in healthcare administration, business administration, finance, accounting, revenue cycle management, or 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.

Responsibilities

• Oversee payer plan lifecycle including participation changes, implementation, maintenance, and termination.
• Audit payer reimbursement against contracted fee schedules and reimbursement methodologies.
• Identify reimbursement discrepancies and underpayments and coordinate recovery with Revenue Cycle and stakeholders.
• Maintain accurate payer plan inventories, participation records, and reimbursement documentation.
• Analyze payer performance, reimbursement trends, and financial opportunities to improve 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.
• 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.

Skills

Payer contracts

Reimbursement analysis

Excel

Data analytics

Project management

Communication

Confidentiality

Education

Bachelor’s degree in healthcare administration

Tools

Ascend

Practice management platforms

Job description

Elite Dental Partners is seeking a Plan Manager to oversee 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.

The role requires a Bachelor’s degree in a related field and 3+ years of payer relations or managed care experience.