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Payor Relations Analyst Jobs (NOW HIRING)

Zynex Medical

Payor Relation Specialist

Denver, CO · On-site

Aptitude for analysis and strategy. * Excellent interpersonal and customer relations skills ... payor relations) and an established network within the healthcare payor space. -3+ years ...

Centria Autism

Clinical Data Analyst

Farmington Hills, MI · On-site

$105K - $115K/yr

The Clinical Data Analyst partners with clinical leadership, payor relations, and operations to translate clinical data into the evidence story that demonstrates Centria's value to payors and ...

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Payor Relations Analyst information

What is the difference between Payor Relations Analyst vs Claims Analyst?

AspectPayor Relations AnalystClaims Analyst
Required CredentialsBachelor's degree in healthcare, business, or related field; certifications like CPC or CHC are commonBachelor's degree in healthcare administration, finance, or related field; certifications like CPC are beneficial
Work EnvironmentHealthcare insurance companies, managed care organizations, or healthcare providersInsurance companies, healthcare providers, or third-party administrators
Employer & Industry UsageUsed in health insurance and managed care sectors to manage payer relationshipsCommon in insurance and healthcare sectors to process and analyze claims

While both roles operate within the healthcare insurance industry, a Payor Relations Analyst primarily manages relationships with payers and ensures smooth communication, whereas a Claims Analyst focuses on processing and analyzing insurance claims. Both roles require healthcare knowledge and communication skills but serve different functions within the healthcare reimbursement process.

Infographic showing various Payor Relations Analyst job openings in the United States as of May 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 67% In-person, and 33% Hybrid job distribution.
Account Manager - Payor Relations

Account Manager - Payor Relations

BioPlus Specialty Pharmacy

Altamonte Springs, FL • On-site

Full-time

Medical, Retirement

Posted 18 days ago

Job description

Company Description
As one of the largest and most respected specialty pharmacies, BioPlus creates a meaningful difference to our patients, prescribers, payers, and pharmaceutical partners.
Our 2 - Hour Patient Acceptance Guarantee gives a quick response to prescribers and patients for critical, time - sensitive treatments. As we continue to grow, we need exceptionally talented, bright, and driven people. If you would like to help us continue to be the innovative leader in our industry, this is your chance to join our team.
Job Description
Position Summary
Responsible for providing support in managing payor relations, program implementation, data feeds as contracted, and other contractual requirements. Provide analysis of contracts, facilitate internal company communication concerning payor clients, and manage payor contract requirements in order to maintain compliance and contract obligations.
Essential Functions:
  • Ensure accurate and timely completion of all assigned and contractual client requirements (reporting, application/contraction completion, presentation, monthly analysis).
  • Serve as the primary contact for assigned accounts, interacting with client contacts to facilitate problem resolution and promote high client satisfaction
  • Work directly with internal stakeholders including finance, IT, legal, operations, account management, contract management, sales and others to define requirements and support successful implementation and sales pull through on payor contracts.
  • Maintain a current request for proposal (RFP) library, coordinate with stakeholders to maintain relevant and accurate information, develop RFP responses as approved by the executive team.
  • Assist the Director of Contract Management with the business development process of contracting and executing new payor relationships.
  • Work with other department, sales/account managers, pharmacy, billing, PCC's and other departments to support company objectives.
  • Engages targeted payors for contracts to allow pending patient dispensing
  • Assist Credentialing Specialist as needed to complete enrollment applications/packages (Medicaid, Part D, MCO)
  • Respond to questions surrounding contracts (reimbursement, benefit design, contracted services)
  • Collate and create monthly, quarterly, and annual payor reports
  • Review and analyze weekly shipped, non-admit, and discharge reports
  • Assist admissions/PA with difficult patient cases
  • Provide insight of changes within plans to sales, admissions, pharmacy, and billing departments
  • Provide analysis of growth potential within each plan and a full region
  • Assist Hemophilia team (reimbursement, plan access, LOA, patient onboarding, etc.)
  • Obtain Letter of Agreement when required for services (workmen's comp/medical services)
  • Announce drug formulary changes at a plan to internal customers
  • Provide analysis and support for VPs of Managed Care, Sr. Director of Contract Management and the SVP Trade
  • Manage, review and follow up of pending contracts and provide support for timely completion, update contract files upon contract execution

Other Duties:
  • Participate and perform other related duties as assigned by Leadership.

Competency:
  • Strong knowledge of specialty pharmacy contracting, payor, PBM's and managed care
  • Must be able to meet time-sensitive deadlines and handle confidential and sensitive information appropriately
  • Ability to work and lead in a team-oriented, collaborative environment.
  • Excellent organization skills required and the ability to work on multiple accounts simultaneously.
  • Maintains compliance with all BioPlus Specialty Pharmacy policies and procedures
  • Strong organizational skills with the ability to manage multiple work streams and implementation projects simultaneously.
  • Ability to rapidly adapt and respond to changes in environment and priorities
  • Demonstrate excellent oral and written communication skills
  • Strong networking skills
  • Demonstrate proficiency in the use of MS Office software; which includes Excel, Word and Outlook
  • Demonstrate the BioPlus C.A.R.T. values
    • Competence
    • Accountability
    • Respect
    • Trust

Qualifications
Qualifications
Education/Experience Requirements:
  • Associate or Bachelor's degree in healthcare related field preferred
  • 3+ years of experience with Healthcare Plans or Specialty Pharmacy

Additional Information
BioPlus offers competitive compensation packages including health care, 401(k), growth potential, and a challenging and exciting work environment.
BioPlus is an Equal Opportunity Employer

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