The Payer Relations Specialist/Manager is responsible for developing and maintaining positive relationships with payers to ensure smooth and efficient billing and reimbursement processes for healthcare services provided by our organization. This role involves negotiating contracts, resolving payment issues, and staying updated on changes in payer policies and regulations. The Payer Relations Analyst will manage relationships between healthcare providers (such as hospitals, clinics, or physician practices) and various payers, including insurance companies, government healthcare programs (like Medicare and Medicaid), and other third-party payers.

• Build and nurture positive relationships with payer representatives to facilitate effective communication and problem resolution.
• Monitor payment processing and reimbursement activities to ensure timely and accurate payment of claims.
• Address and resolve any payment discrepancies, denials, or other billing-related issues with payers.
• Stay informed about changes in payer policies, regulations, and industry trends that may impact reimbursement processes.
• Assist internal teams in understanding payer requirements and resolving billing issues.
• Analyze payer data to identify trends, opportunities for improvement, and areas of concern within associated electronic file formats (ex: 835 (Electronic Remittance Advice) forms, 277 response files (Payer Response), 999 files (Acknowledgement Report) and eligibility files).
• Work closely with internal stakeholders, such as finance, billing, and legal teams, to ensure compliance with payer contracts and regulations.
• Compile and communicate relevant reports to staff members on payer concerns, and opportunities for improvement.
• Maintain Internal Ticketing System.  

• Previous experience in healthcare payer relations, contracting, or revenue cycle management.
• Strong negotiation and communication skills.
• Knowledge of healthcare billing and reimbursement processes.
• Familiarity with healthcare regulations and compliance requirements.
• Proficiency in data analysis and report generation.
• Ability to work independently and collaboratively in a fast-paced environment.
• Attention to detail and strong problem-solving skills.
• Bachelor's degree in healthcare administration, business, finance, or a related field (master’s degree preferred).
• Certification in healthcare revenue cycle management (e.g., CRCR) is a plus (or willingness to obtain).