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.

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.

• 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.