Payer Relations Specialist

Espire Dental•Greenwood Village, CO

21h

About The Position

The Payer Relations Specialist serves as Espire Dental’s primary liaison with dental insurance carriers and third-party payers. The role develops and maintains payer relationships, supports contract evaluation and negotiations, monitors reimbursement trends, resolves escalated payer issues, and advocates for fair and competitive reimbursement across the organization. Working with Revenue Cycle, Operations, Credentialing, Finance, Legal, Procurement, and Practice teams, the Specialist helps optimize payer performance and supports patient access, revenue integrity, and practice profitability. The position analyzes payer contracts, fee schedules, reimbursement and claims patterns, and payer performance; supports network participation assessments; and tracks contract terms, renewals, rate changes, and payer commitments. It coordinates systemic issue resolution, maintains payer scorecards and escalation records, and communicates findings and recommended actions to operational and executive audiences. Success requires analytical judgment, relationship management, dental revenue-cycle knowledge, confidentiality, and consistent follow-through.

Requirements

At least three years of experience in dental or healthcare payer relations, managed care contracting, revenue cycle management, reimbursement analysis, or a related discipline is preferred.
Working knowledge of dental insurance, payer contracts, fee schedules, claims processing, denials, credentialing, and provider network participation.
Experience interpreting contract language and translating reimbursement terms into operational and financial implications.
Intermediate to advanced Microsoft Excel skills.
Strong written and verbal communication skills and the ability to work effectively with payer representatives and internal leaders.
Ability to manage multiple priorities, protect confidential information, and follow through on time-sensitive commitments.

Nice To Haves

Bachelor’s degree in business, healthcare administration, finance, or a related field; relevant experience may substitute for formal education.
Experience with dental practice-management, revenue-cycle, contract-management, or business-intelligence systems.

Responsibilities

Serve as the day-to-day contact for assigned dental insurance carriers, third-party administrators, and payer representatives.
Build payer relationships, maintain contact and escalation information, document meetings and commitments, and represent Espire in payer discussions.
Support review of payer agreements, amendments, participation requirements, reimbursement terms, and fee schedules.
Prepare analyses and materials for contract discussions, renewals, and negotiation strategy; identify material terms, risks, operational requirements, and opportunities.
Maintain contract inventories and track renewal dates, notice periods, rate changes, and outstanding payer commitments.
Support network participation assessments based on reimbursement, access, operational impact, and strategic fit.
Analyze fee schedules, reimbursement trends, procedure-level payments, and payer performance to identify improvement opportunities.
Compare contracted reimbursement with actual payments, escalate material variances or recurring underpayments, and support reimbursement requests with data and business rationale.
Partner with Finance and Revenue Cycle leadership to quantify the impact of proposed payer changes and validate implementation of approved rate updates.
Coordinate resolution of systemic payer issues, including recurring denials, payment delays, incorrect contract loading, inconsistent claim processing, and administrative barriers.
Distinguish isolated claim issues from broader payer patterns and route issues to the appropriate owner.
Prepare escalation summaries documenting the issue, scope, evidence, impact, requested resolution, owner, and deadline; track escalations through closure and communicate status.
Partner with Credentialing and Revenue Cycle teams to resolve enrollment, effective-date, network-status, and provider-loading issues.
Develop and maintain payer scorecards, contract trackers, escalation logs, and reimbursement opportunity reporting.
Monitor reimbursement performance, denial and underpayment trends, resolution times, outstanding escalations, and fee schedule implementation.
Translate payer data into findings and recommended actions for operational and executive audiences, maintaining reliable documentation.
Collaborate with internal teams on payer priorities, provide guidance and updates, and identify workflow or documentation changes to reduce avoidable denials and improve reimbursement accuracy.
Support training and communication related to payer changes, contract requirements, and recurring reimbursement issues.
Perform other duties and special projects as assigned by the Revenue Cycle Manager.