Payer Relations Manager

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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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  (ex: VLOOKUP, sort/filtering/formatting, pivot table, 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 and exclusive of any bonus or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 15% based on performance in the role. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.

Additional Information

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

Technical Requirements (for remote workers only, not applicable for onsite/in office work):

In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. Privia is a better company when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.