Manager, Payer Relations
Role Overview
The Payer Relations Manager owns relationships with commercial and government health plans.
The role supports workable contracts, resolves issues affecting patient access or payment, and reports payer performance to leadership.
The position works with revenue cycle, finance, credentialing, clinical operations, and legal.
Key Skills for This Role
Full Job Posting
About Adaptive Home Health
The company describes its business as an AI-native physical care platform, starting with home health.
Its stated mission is to expand delivered care and reduce administrative work in healthcare.
Role overview
The Payer Relations Manager owns relationships with commercial and government health plans.
The role supports workable contracts, resolves issues affecting patient access or payment, and reports payer performance to leadership.
The position works with revenue cycle, finance, credentialing, clinical operations, and legal.
Key responsibilities
- Serve as primary relationship owner and escalation contact for assigned health plans.
- Support contract negotiations and renewals by analyzing rates, terms, volume, and financial impact.
- Track renewal dates, notice deadlines, and rate changes.
- Partner with revenue cycle to resolve denials, underpayments, payment delays, and authorization issues, and implement preventive process changes.
- Monitor contract compliance, denial rates, AR aging, and escalation trends; report findings and recommendations to leadership.
- Evaluate network participation opportunities and payer changes affecting access or financial performance.
- Coordinate participation issues with credentialing and enrollment, and contract language and disputes with legal and compliance.
- Communicate material payer policy and contract changes to affected teams.
Basic qualifications
- Bachelor’s degree in healthcare administration, business, finance, or a related field, or equivalent experience.
- At least 3 years in payer relations, managed care contracting, revenue cycle, or reimbursement analysis, including direct health-plan work on contracts, claims, or payment issues.
- Working knowledge of reimbursement methods, payer contracts, claims workflows, and causes of denials and underpayments.
- Ability to analyze financial and operational data and make practical recommendations.
- Strong negotiation, relationship management, and project management skills.
Preferred qualifications
- 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.
Benefits
- Competitive salary and equity compensation.
- Health insurance, dental, commuter benefits, and a 401(k) plan with employer contribution.
- Flexible time off; the company expects most employees to take at least three weeks of vacation annually.
- Opportunity for growth in a fast-growing company and a collaborative team.
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