Payer Relations Specialist

ESPIRE DENTAL•Greenwood Village, CO

2d•$70,000 - $90,000

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 evaluations 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, and Practice teams, the specialist helps optimize payer performance in support of patient access, revenue integrity, and practice profitability. The role also identifies reimbursement opportunities and systemic payer issues and supports strategic network participation decisions. The position requires analytical judgment, relationship-management skills, dental revenue-cycle knowledge, and disciplined follow-through. Responsibilities include managing payer contacts and escalations; reviewing agreements, amendments, reimbursement terms, and fee schedules; analyzing reimbursement and payment trends; coordinating systemic issue resolution; maintaining payer reporting and contract records; and partnering with internal teams on payer-related priorities. Other duties and special projects may be assigned by the Revenue Cycle Manager. The position primarily operates in a professional office or remote-work environment and routinely uses a computer, telephone, video conferencing, and standard office equipment. It involves extended periods of sitting, reading, data analysis, and written and verbal communication. Occasional travel may be required for payer or internal meetings. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Requirements

Bachelor’s degree in business, healthcare administration, finance, or a related field preferred; relevant experience may substitute for formal education.
At least three years of experience in dental or healthcare payer relations, managed care contracting, revenue cycle management, reimbursement analysis, or a related discipline 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

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, maintaining productive relationships and representing Espire in payer meetings and issue-resolution discussions.
Maintain payer contact information, escalation pathways, meeting notes, commitments, and follow-up items.
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 contract terms, operational requirements, risks, and opportunities for review by internal teams and leadership.
Maintain contract inventories and track renewal dates, notice periods, rate changes, and outstanding payer commitments.
Support network participation assessments using reimbursement, access, operational impact, and strategic fit.
Analyze fee schedules, reimbursement trends, procedure-level payment patterns, and payer performance to identify improvement opportunities.
Compare contracted reimbursement with actual payments, escalate material variances and recurring underpayments, and support requests for fee schedule increases, contract modifications, and reimbursement corrections.
Partner with Finance and Revenue Cycle leadership to quantify the financial impact of proposed payer changes, and monitor 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 concise escalation summaries, track escalations through closure, and communicate status to affected stakeholders.
Partner with Credentialing and Revenue Cycle teams to address 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, days to resolution, outstanding escalations, and fee schedule implementation status.
Translate payer data into findings and recommended actions for operational and executive audiences, maintaining reliable documentation.
Collaborate with Revenue Cycle, Credentialing, Operations, Finance, Legal, Procurement, and Practice teams on payer-related priorities.
Provide payer guidance and timely stakeholder updates, identify workflow or documentation changes to reduce avoidable denials and improve reimbursement accuracy, and support related training and communications.
Perform other duties and special projects as assigned by the Revenue Cycle Manager.