Payor Relations Manager

Objective and Purpose: The Manager of Payor Relations is responsible for developing and managing relationships with insurance payors to ensure favorable reimbursement rates, efficient claims processing, and overall network optimization for supported specialty practices. This role focuses on negotiating competitive fee schedules, analyzing existing agreements for improvement opportunities, and collaborating with Revenue Cycle Management, Operations, and Clinical Leadership to address payor-related challenges. By staying informed on industry trends, regulatory changes, and evolving reimbursement models, the Manager of Payor Relations proactively adjusts strategies to maintain compliance and maximize revenue opportunities. Serving as a liaison between payors and supported practices, this role provides guidance on contract terms, credentialing, and claims escalation while aligning payor strategies with Specialty1 Partners' commitment to specialist-driven patient care and financial sustainability.

Primary Responsibilities:

• Develop and maintain relationships with insurance payors to negotiate favorable contract terms and reimbursement rates.
• Analyze existing payor agreements to identify opportunities for rate improvements, network expansion, and contract optimization.
• Collaborate with Revenue Cycle Management, Operations, and Clinical Leadership to address payor-related challenges and improve billing efficiencies.
• Monitor industry trends, regulatory changes, and evolving reimbursement models to adjust strategies proactively and ensure compliance.
• Serve as a liaison between payors and supported practices, providing guidance on contract terms, credentialing, claims escalation, and dispute resolution.
• Implement strategies to optimize reimbursement processes, minimize denials and underpayments, and improve cash flow for supported practices.
• Develop and execute initiatives to enhance insurance participation strategies, including in-network and out-of-network positioning.
• Lead contract negotiations and renegotiations to secure competitive rates while balancing cost and quality of care for patients.
• Partner with legal and compliance teams to ensure all agreements meet state and federal regulations.
• Provide ongoing education and support to internal stakeholders on payor policies, reimbursement trends, and contract requirements.
• Track and analyze key performance indicators (KPIs) related to payor performance, reimbursement trends, and contract effectiveness.
• Work closely with credentialing teams to streamline provider enrollment and payor onboarding processes.
• Identify opportunities for strategic payor partnerships to enhance Specialty1 Partners' market positioning and competitive advantage.

Requirements:

• Bachelor's degree in business, healthcare administration, finance, or a related field (Master's preferred).
• Minimum of 5 years of experience in payor relations, managed care contracting, revenue cycle management, or healthcare reimbursement.
• Experience working with specialty dental or medical practices is highly preferred.
• In-depth knowledge of payor contracting, reimbursement methodologies, and healthcare regulations, including Medicare, Medicaid, and commercial payors.
• Strong understanding of fee schedule negotiations, claims adjudication, and dispute resolution processes.
• Familiarity with revenue cycle operations, including billing, coding, credentialing, and collections.
• Strong negotiation and contract management skills with a proven track record of securing competitive payor agreements.
• Ability to analyze complex data, identify trends, and make strategic recommendations to optimize reimbursement.
• Excellent communication and interpersonal skills to build and maintain strong relationships with payors, internal stakeholders, and supported practices.
• Problem-solving and conflict resolution skills to address claims disputes and reimbursement issues effectively.
• Highly organized, detail-oriented, and capable of managing multiple contracts and projects simultaneously.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and healthcare-related software (EHR, practice management, and claims processing systems).
• Experience with contract management systems and data analytics tools is a plus.
• Ability to travel as needed to meet with payors, attend industry conferences, or visit supported practices.
• Strong business acumen and ability to align payor strategies with overall financial and operational goals.

Benefits:

• BCBS High Deductible & PPO Medical insurance Options
• VSP Vision Coverage
• PPO Dental Insurance
• Complimentary Life Insurance Policy
• Short-term & Long-Term Disability
• Pet Insurance Coverage
• 401(k) Plan
• HSA / FSA Account Access
• Identity Theft Protection
• Legal Services Package
• Hospital/Accident/Critical Care Coverage
• Paid Time Off
• Diverse and Inclusive Work Environment
• Strong culture of honesty and teamwork

About Us:

Specialty1 Partners is a practice services organization committed to providing non-clinical, business support services to the nation's leading specialty dental practices. The company was founded in 2019 by four endodontists who wanted to provide unique and differentiated support to specialty dental practices. Originally focusing on support to endodontics practices (under the Endo1 brand), Specialty1 Partners quickly expanded its support to periodontics and oral surgery practices.

Since its founding, Specialty1 Partners has grown rapidly to become one of the largest private owners of specialty dental practices in the US. Headquartered in Houston, TX, Specialty1 Partners is led by its founders and a management team that is focused on ongoing growth and delivery of best-in-class services across its network of practices. Specialty1 Partners currently has over 225 locations across 28 states.

We believe in transparency through the talent acquisition process; we support our team members, past, future, and present, to make the best decision for themselves and their families. Starting off on the right foot with pay transparency is just one way that we are supporting this mission.

Position Base Pay Range

$85,000-$95,000 USD

Specialty1 Partners is the direct employer of non-clinical employees only. For clinical employees, the applicable practice entity listed above in the job posting is the employer. Specialty1 Partners generates job postings and offer letters to assist with human resources and payroll support provided to the applicable practice. Clinical employees include dental assistants and staff assisting with actual direct treatment of patients. Non-clinical employees include the office manager, front desk staff, marketing staff, and any other staff providing administrative duties.

Specialty1 Partners and its affiliates are equal-opportunity employers who recognize the value of a diverse workforce. All suitably qualified applicants will receive consideration for employment based on objective criteria and without regard to the following (which is a non-exhaustive list): race, color, age, religion, gender, national origin, disability, sexual orientation, gender identity, protected veteran status, or other characteristics in accordance with the relevant governing laws. Specialty1 Partners' Privacy Policy and CCPA statement are available for view and download at https://www.specialty1partners.com/privacy-policy/

Specialty1 Partners and all its affiliates participate in the federal government's E-Verify program. Specialty1 further participates in the E-Verify Program on behalf of the clinical practice entities which are supported by Specialty1. E-Verify is used to confirm the employment authorization of all newly hired employees through an electronic database maintained by the Social Security Administration and Department of Homeland Security. The E-Verify process is completed in conjunction with a new hire's completion of Form I-9, Employment Eligibility Verification upon commencement of employment. E-Verify is not used as a tool to pre-screen candidates. For up-to-date information on E-Verify, go to www.e-verify.gov and click on the Employees Link to learn more.

Specialty1 Partners and its affiliates uses mobile messages in relation to your job application. Message frequency varies. Message and data rates may apply. Reply STOP to opt-out of future messaging. Reply HELP for help. View our Privacy & SMS Policy here. By submitting your application you agree to receive text messages from Specialty1 and its affiliates as outlined above.