Adaptive Home Health - Manager, Payor Relations
Requirements
• Bachelor's degree in healthcare administration, business, finance, or a related field, or equivalent experience • 3+ years in payer relations, managed care contracting, revenue cycle, or reimbursement analysis, including direct work with health plans on contract, claims, or payment issues • Working knowledge of reimbursement methods, payer contracts, claims workflows, and the drivers of denials and underpayments • Ability to analyze financial and operational data and turn it into clear, practical recommendations • Strong negotiation, relationship management, and project management skills • Direct experience negotiating or implementing commercial and Medicare Advantage contracts • Familiarity with credentialing, enrollment, and value-based payment arrangements • Experience with contract management, claims analysis, or revenue cycle reporting tools
Responsibilities
• The Payer Relations Manager owns the organization's relationships with commercial and government health plans. This role helps secure workable contracts, resolves issues that affect patient access or payment, and gives leadership a clear view of payer performance. You'll work closely with revenue cycle, finance, credentialing, clinical operations, and legal. • Serve as the primary relationship owner and escalation contact for assigned health plans • Support contract negotiations and renewals with analysis of rates, terms, volume, and financial impact. Track renewal dates, notice deadlines, and rate changes. • Partner with revenue cycle to resolve recurring denials, underpayments, payment delays, and authorization issues, and drive process changes that prevent them from recurring • Monitor payer performance, including contract compliance, denial rates, AR aging, and escalation trends, and report findings and recommendations to leadership • Evaluate network participation opportunities and payer changes that affect patient access or financial performance • Coordinate with credentialing and enrollment on participation issues, and with legal and compliance on contract language and disputes • Communicate material payer policy and contract changes to affected teams • Measures of success • Strong renewal outcomes, timely resolution of escalations, fewer recurring denials and underpayments, faster payments, and accurate payer performance reporting.
Benefits
• Competitive salary and equity compensation • Comprehensive health insurance, dental, and commuter benefits • 401(k) retirement plan with employer contribution • Flexible time off policy — we expect most employees to take at least 3 weeks of vacation per year • Opportunity for growth in a fast-growing company • Collaborative team valuing innovation and problem-solving
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