Payor Relations Coordinator

Job Summary

Under supervision of the RCM Director, The Payor Relations Coordinator is responsible for managing provider credentialing, contracting, and maintaining strong relationships with payors. This position ensures compliance with regulatory requirements, optimizes reimbursement, and collaborates with internal teams to streamline payor-related processes.  

Task Description

• Complete and monitor provider credentialing, enrollment, and contract applications.
• Maintain provider data, credentials, and contract records in compliance with regulations.   
• Oversee contract negotiations, reimbursement analysis, and payor agreements.
• Manage payor relationships and ensure smooth communication between clinicians and payors.
• Collaborate with revenue cycle and billing teams to resolve payor-related discrepancies.
• Track industry trends, regulations, and payor policies to optimize contracts and credentialing processes.
• Maintaining internal databases and records.
• Credentialing & Enrollment: Oversee and maintain credentialing compliance for providers.
• Contracting & Negotiation: Secure favorable payor contracts and reimbursement rates.
• Payor Relations: Foster strong communication with payor representatives.
• Regulatory Compliance: Ensure adherence to state, federal, and payor-specific policies.
• Data & Reporting: Maintain accurate documentation and generate reports on contract performance.

• 3 years of experience in provider enrollment, payer credentialing, or healthcare contracting 
• Physician and facilities credentialing experience   
• Strong knowledge of managed care operations, payor processes, and regulatory compliance.
• Familiarity with California healthcare market and reimbursement methodologies.
• Experience with contract negotiations and maintaining payor relationships.
• Strong negotiation, analytical, and organizational skills.
• Proficiency in Microsoft Office and credentialing databases.
• Ability to work independently and manage multiple priorities.