Manager of Payor Relations - Dental

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.goawsaimobiledataanalyticsmarketing