Payer Relations Manager Full Time Days

East Tennessee Children's Hospital

4d • Onsite

About The Position

The Payer Relations Manager supports the Director of Payer Relations in advancing Dolly Parton Children’s Hospital’s payer strategy and managed care operations across the enterprise, with particular emphasis on behavioral health, home health, ambulatory surgery, and other key service lines. This position leads and coordinates payer Joint Operating Committees, facilitates payer issue resolution, and supports contract implementation and administration on behalf of DPCH, its employed and affiliated providers, and related entities. The role oversees select payer contracting, including shared responsibility for Children’s West Surgery Center, and collaborates with revenue cycle, analytics, credentialing, and operational teams to address denials, payment variances, underpayments, and other payer issues while driving network stability and payer performance.

Requirements

• Bachelor’s degree preferred
• Three years of healthcare, managed care, payer contracting, revenue cycle, healthcare analytics, or related experience required.
• Strong understanding of healthcare payer systems, reimbursement, managed care, and diverse payer mix experience (Commercial and TennCare) and evolving payer policies.
• Ability to support pediatric service lines and programs (e.g., behavioral health, home health, ambulatory services) from a contracting and reimbursement perspective.
• Coding and claims expertise sufficient to interpret denials, bundling, payment variances, and support collaboration with coding/revenue integrity teams.
• Strong analytical and financial skills to translate data, trends, and payer performance metrics to identify risk, revenue optimization opportunities, and denial reduction strategies.
• Communicates clearly and diplomatically with executives, providers, staff, and payers, including in situations requiring influence, negotiation, or conflict resolution.
• High level of professionalism, reliability, responsiveness, adaptability, and resilience in a fast-paced, deadline-driven environment.
• Strong problem-solving skills, with the ability to prioritize multiple projects, manage stress, and maintain composure in high-pressure situations.
• Superior attention to detail in reviewing contract language, fee schedules, and payer communications.
• High proficiency in MS Office Suite (Word, Excel, PowerPoint, Outlook, Teams), with advanced Excel skills for data analysis.
• Comfort using dashboards, data visualization tools, contract management systems, payer portals, and hospital information systems.

Nice To Haves

• Experience with Epic contract management, expected reimbursement tools, or similar systems preferred.

Responsibilities

• Supports the Director of Payer Relations in advancing the organization's payer strategy and managed care operations.
• Leads and coordinates payer Joint Operating Committees.
• Facilitates payer issue resolution.
• Supports contract implementation and administration.
• Oversees select payer contracting, including shared responsibility for Children’s West Surgery Center.
• Collaborates with revenue cycle, analytics, credentialing, and operational teams to address denials, payment variances, underpayments, and other payer issues.
• Drives network stability and payer performance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level