Now is the time to join PDS Health. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today!
Overview:
The Mgr, Plan Partnership manages strategic relationships with dental and medical insurance payors to support reimbursement performance, operational efficiency, provider experience, and patient access. This role partners closely with internal teams and health plan contacts to resolve issues, support contract initiatives, and advance overall payer strategy.
Responsibilities
Manage a portfolio of dental and medical payer relationships.
Develop and maintain productive partnerships with health plan representatives.
Identify opportunities to improve reimbursement, operations, provider experience, and member experience.
Support long-term payer strategies aligned with organizational goals.
Support contract negotiations, fee schedule reviews, amendments, and implementation activities.
Evaluate financial impact of proposed reimbursement and policy changes.
Coordinate internal review of contract language, reimbursement changes, and operational requirements.
Monitor implementation of negotiated terms and ensure timely follow-through.
Serve as the primary contact for escalated payer operational issues.
Collaborate with Credentialing, Revenue Cycle, Clinical Operations, Legal, Finance, and Network Development to resolve payer concerns.
Lead recurring business reviews with assigned health plans.
Track issue resolution and ensure timely follow-up.
Analyze claims, utilization, reimbursement, denial trends, and provider performance.
Prepare reports and executive summaries on partnership performance, trends, and financial impact.
Identify trends and recommend strategic improvements.
Monitor value-based care and quality program performance metrics.
Support new payer initiatives, value-based care programs, pilot projects, and benefit changes.
Coordinate cross-functional project plans, timelines, and stakeholder communications.
Maintain knowledge of payer policies, regulatory requirements, and contractual obligations.
Support compliance with payer agreements and internal requirements.
Document partnership activities and maintain accurate records.
Ensures compliance with all policies and standards, as well as state, federal and other regulatory bodies.
This is not intended to be a comprehensive list of the duties and responsibilities of the position and the duties and responsibilities may change.
Qualifications
Bachelor’s Degree in Arts/Sciences (BA/BS) Business, Healthcare Administration, Finance, Public Health, or related field.
6+ years of experience in healthcare, dental insurance, managed care, provider relations, payer operations, or a related field.
Experience working with commercial insurance, DHMO, PPO, Medicare Advantage, and/or Medicaid products.
Preferred
Experience within a Dental Support Organization (DSO).
Experience with contract negotiations, fee schedules, and reimbursement methodologies.
Knowledge of dental coding, claims processing, credentialing, and provider operations.
Experience supporting value-based care initiatives.
Knowledge/Skills/Abilities
Strong ability to set short-, mid-, and long-term goals and work with non-PDS entities to drive them to completion.
Highly developed team-building, influencing, and collaboration skills.
Ability to direct the work of others and serve as a team leader in attainment of goals.
Ability to interpret and apply policies and procedures.
Ability to draw valid conclusions, apply sound judgment in making decisions, and make decisions under pressure.
Excellent interpersonal and communication skills, with the ability to tailor communication style as needed to a diverse group of carrier contacts.
Ability to interpret a variety of instructions furnished in written, verbal, or diagram form.
Ability to multi-task effectively without compromising the quality of the work.
Excellent interpersonal, oral, and written communication skills.
Detail-oriented, organized, process-focused, problem solver, proactive, and ambitious.
Ability to draw conclusions and make independent decisions with limited information.
Self-motivated, reliable individual capable of working independently as well as part of a team.
Benefits
Medical, dental, and vision insurance
Paid time off
Tuition Reimbursement
401K
Paid time to volunteer in your local community
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PDS Health is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.