Payer Relations Manager

Privia Health; United States; Remote; USD 70,000 - 80,000; Full time

Job summary

Privia Health is seeking a Payer Relations Manager to enhance relationships with health plans, ensuring efficient revenue cycle operations. The role involves addressing payer-related issues, building stakeholder relationships, and providing insights on performance metrics. Ideal candidates will have a strong background in healthcare administration and payer relations, with exceptional communication skills. This position offers a competitive salary and bonus structure.

Benefits

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Pet Insurance

401K

Paid Time Off

Wellness Programs

Qualifications

• Strong experience in payer relations and RCM required.
• Proven ability to build and maintain relationships with external stakeholders.

Responsibilities

• Manage and optimize relationships with health plans.
• Monitor and manage ongoing payer issues, including enrollment worklists.
• Track and report on payer performance metrics.

Skills

Problem Solving

Analytical Skills

Communication

Education

Bachelor’s degree in healthcare administration

Master’s degree

Tools

Microsoft Excel

athenaNet

Cognizant TriZetto

Job description

Company Description

Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Job Description

The Payer Relations Manager will be responsible for managing and optimizing relationships with health plans to ensure effective and efficient revenue cycle operations. This role involves addressing ongoing payer-related issues, including enrollment worklists, underpayment challenges, and billing concerns, while maintaining open lines of communication with market leadership and payer contracting teams regarding national payer trends. Additionally, the Payer Relations Manager will build strong relationships with key stakeholders at health plans to promote collaboration and resolve systemic issues.

Primary Job Duties

1. Payer Relationship Management:

• Serve as the primary point of contact for payer representatives to address and resolve issues related to enrollment, underpayments, and billing challenges.
• Develop and maintain productive relationships with key stakeholders at health plans to ensure open communication and timely issue resolution.
• Facilitate regular meetings with payers to review performance metrics, address concerns, and discuss opportunities for improvement.

Issue Escalation and Resolution:

• Monitor and manage ongoing payer issues, including enrollment worklists, claim denials, underpayments, and other billing challenges.
• Escalate unresolved or recurring issues to payer representatives and internal leadership as needed.
• Collaborate with internal teams to analyze root causes of payer-related issues and implement corrective actions.

National Payer Communication:

• Provide market leadership and payer contracting teams with regular updates on national payer trends, challenges, and changes that may impact operations.
• Prepare and deliver detailed reports on payer performance, industry developments, and contract compliance.
• Act as a liaison between internal teams and payer contracting teams to align strategies and address systemic challenges.

Collaboration and Coordination:

• Work closely with operational teams, including billing, revenue integrity, and contracting, to ensure alignment on payer strategies and issue resolution.
• Participate in cross-functional meetings to share insights on payer performance and support strategic planning.
• Support payer contracting teams in negotiations by providing data-driven insights on payer behavior and performance.

Stakeholder Engagement:

• Build rapport and maintain strong relationships with key stakeholders at health plans, fostering trust and collaboration.
• Advocate for the organization’s interests while working with payers to identify mutually beneficial solutions.
• Stay informed about payer priorities and initiatives to better anticipate and address potential issues.

Performance Monitoring and Reporting:

• Track and report on payer performance metrics, including claim processing times, underpayment trends, and denial rates.
• Provide actionable insights to leadership based on data analysis and trends.
• Ensure compliance with payer contracts and organizational goals.

Qualifications

• Bachelor’s degree in healthcare administration, business, or a related field (Master’s degree preferred).
• Strong experience in payer relations and RCM required.
• Strong understanding of payer contracting, billing processes, and healthcare regulations.
• Proven ability to build and maintain relationships with external stakeholders, including health plans.
• Excellent problem-solving and analytical skills, with the ability to identify trends and develop strategic solutions.
• Exceptional communication and interpersonal skills, with experience in presenting to leadership.
• Advanced Microsoft Excel skills strongly preferred (e.g., VLOOKUP, sort/filtering/formatting, pivot tables, and formulas).
• Experience using athenaNet and Cognizant TriZetto products preferred.

The salary range for this role is $70,000 to $80,000 in base pay, exclusive of any bonus or benefits (medical, dental, vision, life, pet insurance, 401K, paid time off, and wellness programs). The role is also eligible for an annual bonus targeted at 15% based on performance and restricted stock units. The final offer will depend on experience, education, and location.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Technical Requirements (remote workers only):

Minimum internet speeds of 5 MBPS download and 3 MBPS upload are required. Use speedtest.net to verify your connection before starting. Employees working from home may be eligible for expense reimbursement.

Privia Health promotes a diverse and inclusive work environment and encourages all qualified individuals to apply regardless of protected characteristics.