Cdm And Payor Relations Analyst

The vision of Smile Doctors is our people-first culture which creates an environment of passionate, caring Team Members dedicated to providing fun and encouraging relationships with each other and our patients. Smile Doctors offers every Team Member the opportunity to be a part of something bigger. We focus on the importance of the individual and recognize that each person on our Team has something great to offer. We recognize talents and strengths and take care to nurture those abilities to help our Team Members grow into successful people in their careers, in our organization, and beyond.

We are looking for a CDM & Payor Relations Analystto join our team.

If you are looking for an opportunity to be a part of a growing company and industry leader, Smile Doctors is the place for you. We operate the largest national network of orthodontic clinics with locations in more than 20 states.  At Smile Doctors, we excel at providing exceptional patient care.

What We Offer

• Competitive salary
• Medical, dental, vision and life insurance
• Short and long-term disability coverage
• 401(k) plan
• 3 weeks paid time off in your first year + paid holidays

• Discounts on braces and clear aligners for you and your family members

What You'll Do

• Utilizes spreadsheets, systems, and data models to conduct payor rate analyses to determine the best in-network rate for incoming new practices and any payor contract negotiations
• Works with payors to determine in-network status and assists in negotiating optimum rates to maximize profitability
• Hosts payor rate analysis meetings with internal RCM and Payor Relations leadership to review fee schedules and rates for newly acquired and converted practices 
• Updates and maintains internal systems and Credentialing/Payor Contracting software with current payor data and fee schedules
• Creates and utilizes financial models to determine profitability for new and existing payor agreements and associated fee schedules
• Uses reporting tools provided by Smile Doctors such as SQL, Credential Stream, or PowerBI to assess and analyze data
• Manages fee schedules and contract records in the Credentialing/Payor Contracting software to provide timely updates to the RCM team and external Smile Doctor stakeholders
• Stays abreast of renewals, amendments, and other contract changes
• Assists with data needs of the Payor Relations department for a variety of projects
• Serves as a liaison with RCM and clinic personnel regarding ongoing contract and rate compliance to support key business functions
• Updates and maintains the charge data master (CDM) to reflect new/updated office fee schedules, chargeable services, promotions, and discounts
• Conducts quality assurance processes to ensure payor rates calculate accurately in the patient facing contracting system

What You'll Need

• High School Diploma or equivalent required
• Bachelors Degree in Business preferred
• Minimum 5 years of healthcare revenue cycle or payor contracting experience required
• Dental or Orthodontic payor experience preferred but not required
• Intermediate analytical, critical thinking, planning, and organizing skills required
• Intermediate knowledge of MS Office Applications with proficiency in SharePoint and Excel

This is the perfect opportunity to grow with an expanding organization! Apply today!

Smile Doctors and all our affiliating practices are proud to be an equal opportunity workplace and welcome diversity in our organization.  We do not discriminate against any team member or applicant for employment regardless of age, race, color, national origin, religion, disability, veteran status, sex, sexual orientation, or gender identity.