Payor Relations Workflow Coordinator

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

• Monitor shared inboxes, work queues, and tracking tools for contracting, licensure, credentialing, payor portal administration, and payor policy research requests to ensure all work is logged and prioritized appropriately.
• Assign and distribute work to team members based on work type, regulatory urgency, deadlines, and capacity.
• Track work in progress and completed work across all Payor Relations functions to ensure adherence to established SLAs and due dates.
• Review completed contracting, licensure, credentialing, portal updates, and policy research outputs prior to submission or publication to verify accuracy and completeness.
• Validate that required documentation, forms, screenshots, and supporting evidence are complete and correctly prepared before external submission or internal distribution.
• Identify errors, omissions, or inconsistencies in work products and return items for correction prior to submission.
• Maintain visibility into backlog, expirations, recurring updates, and policy review cycles; escalate risks or delays to leadership as needed.
• Coordinate workflow handoffs between contracting, credentialing, licensing, payor policy research, and portal administration to prevent bottlenecks.
• Ensure consistent use of tracking logs, worklists, and status updates across all Payor Relations work streams.
• Provide routine status updates to leadership on workload, quality trends, upcoming expirations, and policy or portal-related deadlines.

ANCILLARY DUTIES AND RESPONSIBILITIES

• Support onboarding and ongoing coaching related to workflow expectations and quality standards across Payor Relations functions.
• Identify recurring quality issues, rework drivers, or workflow inefficiencies and surface recommendations for improvement.
• Assist with documentation and maintenance of standard operating procedures for contracting, licensure, credentialing, portal administration, and payor policy research.
• Support audit readiness by ensuring submissions, screenshots, correspondence, and confirmations are properly retained.
• Collaborate with Managers and Directors to refine prioritization, escalation criteria, and workload balancing.
• Help standardize handoff processes between functional areas to ensure seamless execution.
• Track and report common error types, corrections, or trends affecting timeliness and quality.
• Provide back-up workflow and quality review support during peak volumes or coverage gaps.
• Participate in cross-functional coordination as needed to support resolution of payor or network issues.
• Perform other duties and projects as assigned to support Payor Relations operational objectives.

MINIMUM REQUIREMENTS OR QUALIFICATIONS

Education /Experience :

• High School Diploma or (GED) General Education Degree;
  Minimum 4–6 years of experience in healthcare payor relations, credentialing, licensing, contracting, revenue cycle operations, or a related administrative or compliance function.

Skills:

Language:
Ability to read, analyze, and interpret medical supply publications, technical procedures, and/or operational training tools. Ability to write internal and external business correspondence. Ability to effectively present information and respond to questions from management, team members, and/or customers.

Math:
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. Ability to apply intermediate math skills.

Reasoning:
Ability to solve practical problems and deal with a variety of variables. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Advanced analytical reasoning to include ability to forecast exponentials within work flow processes and reason against outside factors.

Computer:
Intermediate computer skills and knowledge of Microsoft Office Applications, Access or other database software.

Telecommunications: ability to utilize or knowledge of call center telecommunications software (i.e. dialer systems)

Licensure or Certifications required:
No certifications required

WORK REQUIREMENTS

• Ability to work evenings and weekends

PHYSICAL DEMANDS (The physical demands described here…