Payor Relation Specialist

Overview Role focused on payor relations, credentialing support, and monitoring payor performance metrics. Responsible for building and maintaining relationships with third-party payors and coordinating with cross-functional teams to maximize contracted payor value. Responsibilities Review correspondence, provider manuals, and provider policies as needed Support accuracy of payor performance scorecard metrics Manage credentialing requests, including initial and ongoing credentialing Coordinate payor meetings Develop, maintain, and present to leadership the KPIs/metrics related to areas of responsibility Represent the payor relations function as a core team member on cross-functional projects Core Competencies & Skills Adaptability & Innovation - Exhibits flexibility in adapting to changing priorities and departmental shifts, quickly implements feedback, and applies creative problem solving to overcome barriers and drive continuous process improvements Collaboration & Communication - Communicates professionally and clearly, actively listens, provides accurate support to relevant teams, and fosters a cooperative work environment Quality & Accuracy - Produces work with attention to detail, minimal errors, and thorough verification Quantity & Productivity - Manages time and resources to meet deadlines and departmental goals; takes initiative to be autonomous in daily responsibilities Reliability - Demonstrates punctuality, minimizes disruptions, and communicates schedule changes proactively Technical Proficiency & Knowledge - Understands processes, software, and resources required for the role and applies technical skills in line with department standards Essential Job Duties & Responsibilities Build trusting and professional relationships with third-party payors Support initiation, management, and expansion of contracted relationships with payors at desired reimbursement rates and terms Support quarterly strategic and tactical plans to gain contracts with targeted payors Coordinate prioritization of payor relationships to align with customer base and organizational focus Explore multiple payor types (e.g., MCOs, HMOs, PPOs, IPAs, self-insured employers, unions) Understand and support relationships with influencers in new healthcare models (e.g., ACOs, IHN, PCMH) and large employer groups Educate Sales and Marketing teams and other departments on the payor landscape Collaborate with Sales pre-contract to secure contracts and post-contract to maximize utilization Correspond with payor representatives via phone and email professionally Provide requested information to insurance carriers and other payors Maintain accurate records and provide detailed notes in payor files Support procurement of payor contracts when beneficial for Altivera Speak to and educate payors about Altivera Medical's mission, vision, and products Monitor and identify market trends Other duties as assigned A strong customer-focused mindset Meet goals outlined by department leadership Minimum Job Qualifications Genuine interest in helping people Ability to speak confidently and accurately during negotiation and sales conversations Strong investigative thinking and critical thinking skills to determine payor actions and next steps Ability to exercise independent judgment, discretion, and confidentiality; capable of making complex decisions Excellent written and verbal communication skills and strong organizational skills Superior phone communication skills Minimum of 3 years' experience in a healthcare-oriented position Knowledge of the healthcare insurance industry Understanding of key metrics and performance measures Aptitude for analysis and strategy Excellent interpersonal and customer relations skills Negotiation and conflict resolution abilities Creative problem-solving abilities Detail-oriented in a fast-paced environment Ability to travel occasionally as needed Preferred Strong knowledge of the health insurance industry with an established payor relations network 3+ years’ experience with CMS (Medicare/Medicaid) and/or The Joint Commission Education Requirements Bachelor’s Degree or equivalent experience; a college degree is preferred #J-18808-Ljbffr Zynex Medical