Plan Manager

The role

The Plan Manager oversees payer plan participation, reimbursement accuracy, fee schedule maintenance, and underpayment recovery. This role partners cross-functionally to optimize payer reimbursement and support strategic payer initiatives.

What you will do

• 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.
• Maintain accurate payer plan inventories, participation records, and reimbursement documentation.
• Analyze payer performance, reimbursement trends, and financial opportunities.
• Partner with Credentialing, Revenue Cycle, Operations, and Finance to resolve payer-related issues.
• Support payer contract administration, fee schedule updates, and implementation of reimbursement changes.
• 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.

Required qualifications

• 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.
• 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.

Nice to have

• Bachelor’s degree, in healthcare administration, Business Administration, Finance, Accounting, Revenue Cycle Management, or a related field
• Experience supporting payer enrollment, participation management, reimbursement analysis, or contract administration
• Experience working within a multi-site healthcare or dental organization, preferably a Dental Support Organization (DSO)
• Experience using healthcare reporting systems, practice management platforms, and data analytics tools
• Experience with Ascend or similar practice management systems

Benefits

• Professional development
• Promoting internally when appropriate

About the company

Elite Dental Partners is an Equal Opportunity Employer. They are driven by a vision to provide an elite patient experience tailored to patient needs.