Payor Relations Specialist

The Payor Relations Specialist is responsible for providing service and support to the employed and independent physician networks. The Payor Relations Specialist will work as the liaison between the organization, healthcare providers and payor partners and will be responsible for creating long-term relationships with providers and payors. The Payor Relations Specialist will engage with providers regularly to ensure they are appropriately educated on payor products, policies, procedures, and will work with the providers to resolve claim issues as well as assist in contract reviews, and address contract related questions involving fee schedule comparisons and analysis.

Key Responsibilities:

• Initiating and maintaining effective channels of communication with matrix partners, providers and payors.
• Establishing and maintaining relationships with healthcare providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service.
• Conducting training of providers on policies, procedures, service lines, and available technology as needed.
• Gathering, reviewing, and submitting relevant documentation needed for claim issue resolution.
• Managing healthcare provider relationships to achieve company strategies and goals.
• Maintaining a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare.
• Assist in the review and analysis of payor agreements to ensure favorable terms for participating providers as needed.
• Communicate contract terms and provisions to internal teams and clients.
• Assist in preparing contract-related communications for board meetings as needed.
• Serve as the primary point of contact for contractual issues.
• Address concerns regarding claims payment timeliness and adherence to contracted rates.
• Utilize payor-specific websites, systems, and portals to gather and verify information.
• Stay informed on payor policies, procedures, and administrative requirements.
• Maintain up-to-date knowledge of industry trends and educational resources
• Track and manage issues on behalf of participating providers using appropriate tools.
• Provide regular status updates to supervisors, co-workers, and stakeholders.
• Prepare and distribute relevant information to practices and management teams.
• Identify opportunities to enhance processes and customer service for participants.
• Implement best practices in payor relations and contract management.

Qualifications:

• Bachelor's degree in Healthcare Administration, Business, or related field; or equivalent work experience
• Minimum of 5 years of experience in the healthcare industry, preferably with physician practice focus
• Strong analytical skills with the ability to interpret complex contractual and financial data
• Excellent verbal and written communication skills
• Proficiency in Microsoft Office Suite, particularly Word and Excel
• Ability to work independently and manage multiple priorities

Additional Requirements:

• Ensure strict confidentiality of corporate, client, and patient information.
• Engage in continuous professional development and job-related training.
• Attend IPA and CIN meetings as required.
• Perform other duties as assigned.

Key physical and mental requirements:

• Ability to lift up to 50 pounds
• Ability to push or pull heavy objects using up to 50 pounds of force
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving
• Ability to travel to multiple locations to support business needs as required

FLSA Classification: Non-exempt

Southeast Primary Care Partners is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

12/2024