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Payor Relations Manager

Sonrava Health

Orange (CA)

On-site

Full time

21 days ago

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Job summary

Sonrava Health is seeking a Payor Relations Manager to serve as a key liaison between dental practices and third-party payors. This role involves maintaining payor relationships, resolving insurance issues, and supporting compliance through quality management and audits. Ideal candidates will have 3-5 years of experience in healthcare payor relations and strong communication skills.

Benefits

Medical insurance

Vision insurance

401(k)

Paid maternity leave

Paid paternity leave

Disability insurance

Qualifications

3–5 years of experience in dental or healthcare payor relations.
Strong working knowledge of CDT codes and dental billing.
Experience handling formal payor complaints and QM audits.

Responsibilities

Maintain payor Provider Guides and ensure accurate fee schedules.
Lead resolution of escalated payor complaints.
Coordinate internal responses to payor-initiated audits.

Skills

Communication

Analytical mindset

Negotiation

Tools

Microsoft Office

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This range is provided by Sonrava Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$28.00/hr - $33.00/hr

Overview

As a Payor Relations Manager within our Dental Service Organization (DSO), you will act a key liaison between our multi-site dental practices and third-party payors. This role is responsible for maintaining strong payor relationships, resolving mid-level insurance issues, and supporting compliance through complaint management and quality audit preparation.

Responsibilities

Payor Guidelines & Relations:

Maintain payor Provider Guides, ensuring accurate fee schedules, and terms across all locations.
Engage with payor account managers, initiating regular check-ins to review network performance and resolve outstanding issues.
Lead the resolution of escalated payor complaints, including those related to patient grievances, service coverage disputes, and claim denials.
Coordinate with clinical and billing teams to gather supporting documentation and formulate compliant, timely responses.
Maintain a centralized complaint tracking system to monitor trends, root causes, and resolution outcomes.
Ensure responses to formal complaints and regulatory inquiries are thorough, timely, and aligned with contractual and legal standards.

Quality Management (QM) & Audit Support:

Coordinate internal responses to payor-initiated audits, quality assurance reviews, and documentation requests.
Work closely with compliance and clinical leadership to ensure accurate, complete, and audit-ready patient records.
Monitor payor quality metrics and ensure clinical documentation and billing practices align with payor QM requirements.
Serve as the liaison for QM corrective action plans when required by payors, ensuring timely follow-through and implementation.

Data Analysis & Tracking:

Track payor performance metrics including denial rates, complaint trends, and appeal outcomes.
Develop and present actionable reports to senior leadership to inform strategic decision-making.
Training & Communication:
Educate internal teams on payor policy changes, documentation requirements, and best practices for complaint and audit readiness.
Partner with compliance and operations to continuously refine internal workflows based on audit outcomes and complaint trends.

Qualifications

3–5 years of experience in dental or healthcare payor relations, contract negotiation, and/or claims resolution within a DSO or insurance environment.
Strong working knowledge of CDT codes, dental billing, and documentation standards.
Experience handling formal payor complaints, appeals, and QM audits.

Skills

Exceptional communication, documentation, and negotiation skills.
Analytical mindset with attention to compliance and audit detail.
Ability to manage sensitive complaint and audit data with discretion.
Proficiency in dental software systems and Microsoft Office, particularly Excel and SharePoint.

Company Overview

Today, Sonrava Health has grown to 6,000 teammates who care for 4 million patients each year and support dental specialists holistically in many aspects of patient care. Together, our teammates create value in dental care by aligning around a common goal: building access, ensuring efficient and productive schedule management and delivering positive patient outcomes, all at a high value.

With nearly 600 offices in 21 states, building on a proven platform of success, the brand will continue to expand access to dental care with a mission of advancing whole-person health for patients from all backgrounds.

A geographically diverse, multi-specialty organization with a unique mix of providers and payors, Sonrava Health is comprised of several companies – including Western Dental & Orthodontics, Western Dental Kids, Brident Dental & Orthodontics, LooksBrite Optometry Centers, Vital Smiles, DentalWorks, and Perfect Teeth – all united in our commitment to quality, value and innovation in care.

Sonrava Health represents who we are today and where we are going—and the growing career opportunities for you.

#PayorRelations #PayerRelations #PayerRelationsManager #PayerContracting #ManagedCare #HealthcareJobs #ProviderNetwork #RevenueCycle #HealthPlanRelations #ContractNegotiation #HiringNow

Seniority level

Seniority level
Mid-Senior level

Employment type

Employment type
Full-time

Job function

Job function
Administrative, Accounting/Auditing, and Consulting
Industries
Hospitals and Health Care

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

Paid maternity leave

Paid paternity leave

Disability insurance

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