Payer Relations Specialist

Job Summary

Supporting managed care operations, the full-time Payer Relations Specialist will serve as the primary liaison with assigned third-party payers, managing relationship communications, issue tracking, and performance monitoring in a remote role based in Ohio.

Key responsibilities

• Serve as the operational contact for assigned payers, managing communications and issue escalation
• Monitor payer policy and reimbursement changes, assessing their impact on pediatric services
• Coordinate payer meetings and facilitate the resolution of operational issues such as claim denials and processing errors

Required qualifications

• Bachelor's degree in Healthcare Administration, Business, Communications, or a related field preferred
• Minimum of 2 years of experience in payer relations, managed care, or revenue cycle within a healthcare setting
• Working knowledge of payer operations, including prior authorization and claims adjudication
• Understanding of pediatric healthcare reimbursement and payer requirements, including Medicaid and commercial insurers
• Proficiency in Microsoft Office applications, especially Excel, Word, and PowerPoint