JOB SUMMARY

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. The Plan Manager oversees payer plan participation, reimbursement accuracy, fee schedule maintenance, and underpayment recovery across the organization. This role partners cross-functionally to optimize payer reimbursement, maintain accurate payer records, identify financial opportunities, and support strategic payer initiatives.

ESSENTIAL JOB RESPONSIBILITIES

• Manage the payer plan lifecycle, including participation changes, implementation, maintenance, and termination.
• Audit payer reimbursement against contracted fee schedules and applicable reimbursement methodologies.
• Identify reimbursement discrepancies and underpayments and coordinate recovery efforts with Revenue Cycle and other stakeholders.
• Maintain accurate payer plan inventories, participation records, and reimbursement documentation.
• Analyze payer performance, reimbursement trends, and financial opportunities to improve reimbursement outcomes.
• Partner with Credentialing, Revenue Cycle, Operations, and Finance to resolve payer-related issues and improve processes.
• Support payer contract administration, fee schedule updates, and implementation of reimbursement changes.

OTHER JOB RESPONSIBILITIES

• Participate in special projects, acquisitions, implementations, integrations, and operational initiatives.
• Assist with payer-related escalations and issue resolution.
• Support departmental objectives and organizational strategic initiatives.
• Perform other duties as assigned.

REQUIRED EDUCATION AND EXPERIENCE

• Bachelor’s degree, in healthcare administration, Business Administration, Finance, Accounting, Revenue Cycle Management, or a related field preferred.
• Minimum three (3) years of experience in payer relations, managed care, healthcare contracting, credentialing, revenue cycle management, or related healthcare administration.
• Experience auditing payer reimbursement against contractual fee schedules and reimbursement methodologies required.
• Experience supporting payer enrollment, participation management, reimbursement analysis, or contract administration preferred.
• Experience working within a multi-site healthcare or dental organization, preferably a Dental Support Organization (DSO), preferred.
• Experience using healthcare reporting systems, practice management platforms, and data analytics tools preferred.

QUALIFICATIONS

• Knowledge of payer contracts, reimbursement methodologies, fee schedules, claims adjudication, and network participation requirements.
• Understanding of healthcare revenue cycle operations, payer enrollment processes, and credentialing workflows.
• Ability to interpret contracts, amendments, reimbursement schedules, and payer policy documentation.
• Proficiency in Microsoft Excel, including formulas, pivot tables, lookups, and data analysis.
• Strong analytical, organizational, and problem-solving skills.
• Ability to manage multiple projects, priorities, deadlines, and stakeholder expectations.
• Strong verbal, written, presentation, and interpersonal communication skills.
• Ability to prepare reports, dashboards, and financial analyses for leadership.
• Demonstrated attention to detail and commitment to data accuracy.
• Ability to maintain confidentiality when handling proprietary business and reimbursement information.
• Strong project management and process improvement capabilities.
• Experience with Ascend or similar practice management systems preferred.

PHYSICAL REQUIREMENTS

• Frequently remains in a stationary position while performing computer-based work.
• Frequently operates a computer, telephone, and other standard office equipment.
• Occasionally moves about offices and meeting locations.
• Travel up to 25% may be required.
• Frequently communicates with employees, leaders, providers, and payer representatives.
• Frequently reviews electronic and printed documentation.

The above statements are intended to provide a general overview and level of work being performed by most people assigned to this job. They are not intended to be a list of all responsibilities, duties and requirements.  Additional duties can be assigned as determined.

Elite Dental Partners is an Equal Opportunity Employer. We support a diverse workforce.