Payor Relations Manager

Overview

As a Payor Relations Manager within our Dental Service Organization (DSO), you will act a key liaison between our multi-site dental practices and third-party payors. This role is responsible for maintaining strong payor relationships, resolving mid-level insurance issues, and supporting compliance through complaint management and quality audit preparation.

Responsibilities

• Payor Guidelines & Relations:
  • - Maintain payor Provider Guides, ensuring accurate fee schedules, and terms across all locations.
  • - Engage with payor account managers, initiating regular check-ins to review network performance and resolve outstanding issues.
• Complaint Resolution:
  • - Lead the resolution of escalated payor complaints, including those related to patient grievances, service coverage disputes, and claim denials.
  • - Coordinate with clinical and billing teams to gather supporting documentation and formulate compliant, timely responses.
  • - Maintain a centralized complaint tracking system to monitor trends, root causes, and resolution outcomes.
  • - Ensure responses to formal complaints and regulatory inquiries are thorough, timely, and aligned with contractual and legal standards.
• Quality Management (QM) & Audit Support:
  • - Coordinate internal responses to payor-initiated audits, quality assurance reviews, and documentation requests.
  • - Work closely with compliance and clinical leadership to ensure accurate, complete, and audit-ready patient records.
  • - Monitor payor quality metrics and ensure clinical documentation and billing practices align with payor QM requirements.
  • - Serve as the liaison for QM corrective action plans when required by payors, ensuring timely follow-through and implementation.
• Data Analysis & Tracking:
  • - Track payor performance metrics including denial rates, complaint trends, and appeal outcomes.
  • - Develop and present actionable reports to senior leadership to inform strategic decision-making.
• Training & Communication:
  • - Educate internal teams on payor policy changes, documentation requirements, and best practices for complaint and audit readiness.
  • - Partner with compliance and operations to continuously refine internal workflows based on audit outcomes and complaint trends.

Qualifications

• - 3–5 years of experience in dental or healthcare payor relations, contract negotiation, and/or claims resolution within a DSO or insurance environment.

  - Strong working knowledge of CDT codes, dental billing, and documentation standards.

  - Experience handling formal payor complaints, appeals, and QM audits.

  Skills

  - Exceptional communication, documentation, and negotiation skills.

  - Analytical mindset with attention to compliance and audit detail.

  - Ability to manage sensitive complaint and audit data with discretion.

  - Proficiency in dental software systems and Microsoft Office, particularly Excel and SharePoint.

  Work Environment

  - On Site; occasional travel to practice sites or payor meetings.