Payor Relations & Dispute Resolution

Payor Relations works to support the Managed Care Department and UTMB by acting as a liaison between the hospital system and the insurance company (Payor/Payer). This small team handles several key responsibilities to ensure proper communication and escalation of issues between both parties.

Services

Claims Resolution and Escalation

Working along-side Revenue Cycle Operations, Payor Relations acts as a point of contact for resolving claim denials, underpayments, and other payment discrepancies with insurance payers. Payor Relations collaborates with Revenue Cycle Operations to investigate issues, initiate escalations, and expedite payments.

Payor Communication

Serving as a liaison between UTMB and payors to address operational issues, answer questions, and clarify policy changes. Our team works to facilitate clear communication to maintain positive working relationships.

Education

Assisting in educating internal staff on payor guidelines, policies, and any updates to reimbursement procedures, ensuring that departments are informed of changes that may impact claims or revenue.