Create, set agendas for, and lead Joint Operating Committee (JOC) calls with payors to resolve systemic issues.
Lead managed care contract negotiations, with a primary focus on government payors.
Act as the final point of escalation for complex claims, credentialing disputes, and high-level third-party vendor issues.
Ensure the organization maintains current fee schedules and stays updated on timely filing and claim form requirements.
Partner with the RCM team to identify and fix systemic causes for incorrect payments, authorization hurdles, and credentialing gaps.
Collaborate with all parties to develop denial prevention methods and oversee the follow-up on Accounts Receivable to ensure claims are processed or appealed.
Actively engage in the research, setup, and testing of new payor information within EMR systems.
In partnership with teammates, analyze data sets to perform payor contract modeling and evaluate the financial viability of existing and new agreements.
Own the delivery of updates for the Monthly Operational Review (MOR) and provide field leadership with actionable performance reporting.
Identify and resolve complex reimbursement issues through targeted data-driven analysis and rate reviews.
Assist Patient Coordinators (PCs) and patients with billing inquiries; work cross-functionally to resolve user issues across all departments.
Maintain professional, direct communication with payors via phone and email to facilitate rapid problem-solving.

High School Diploma or GED required; Bachelor’s degree in Healthcare Administration or related field preferred.
3–5 years of experience in healthcare RCM, managed care, or payor relations.
Advanced skills in Microsoft Office Suite (Excel, Word, Outlook, and Access).
Proven ability to analyze complex data sets and develop financial tools for leadership.
Exceptional oral and written communication skills; comfortable leading professional calls with external stakeholders and presenting to executive leadership.
A high sense of urgency, the ability to prioritize tasks in a fast-paced environment, and a commitment to quality customer service.

Generous PTO (Paid Time Off) plans and paid holidays.
Hybrid and remote work flexibility.
Eligibility for full benefits package beginning within your first month of employment.
Empowering Values: Live by values that prioritize teamwork, growth, and serving others.

Payer Strategy Manager

Key skills