Payor Relations Specialist

Are you interested in harnessing technology and AI to transform healthcare?

At XiFin, we believe a healthier, more efficient healthcare system starts with strong financial and operational foundations. Our innovative technologies help diagnostic providers, laboratories, and healthcare systems manage complexity, drive better outcomes, and stay focused on what matters most: patient care.

We’re on a mission to simplify the business side of healthcare—and we know that mission takes people from all backgrounds and experiences. Whether you’re early in your career or bringing years of expertise, we welcome your perspective, your curiosity, and your passion. We value individuals who ask questions, challenge the status quo, and want to grow while making a real difference.

About The Role

The Payor Relations Analyst plays a critical role in driving financial and operational optimization for our clients by leveraging advanced expertise in Electronic Data Interchange (EDI), healthcare payor relationship management, and integrated platform operations spanning both laboratory and pharmacy services. This position requires a seasoned professional with a deep understanding of healthcare revenue cycle operations, strong analytical capabilities, and proven experience in navigating the complexities of payor requirements and data exchange standards.

You will serve as a subject matter expert, lead more complex initiatives, and act as a key liaison between internal stakeholders, technology teams, and external payors.

This position will be located at one of our offices in Dallas, TX or Charleston, SC.

How you will make an impact:

In this role, you’ll:

• Strategic EDI & Payor Management
• Serve as the primary point of contact for assigned payors, building and maintaining high-value relationships that enhance claim acceptance rates and expedite issue resolution.
• Lead advanced EDI configuration and troubleshooting for both lab and pharmacy platforms, ensuring seamless integration and compliance with X12 transaction standards (837, 835, 277, 270/271, etc.).
• Proactively monitor transaction data to identify systemic issues, trends, and opportunities for automation or process improvement.
• Integrated Platform Oversight
• Provide subject matter expertise for both laboratory and pharmacy revenue cycle workflows, ensuring cross-functional alignment of payor policies, configurations, and reimbursement processes.
• Coordinate and oversee initiatives to unify EDI and payor data processes across multiple systems, ensuring accurate and consistent performance metrics.
• Anticipate regulatory and industry changes impacting lab and pharmacy EDI operations and recommend proactive adjustments.
• Advanced Data Analysis & Reporting
• Independently conduct complex SQL-based queries and data analysis to identify trends, anomalies, and revenue impact opportunities.
• Develop and deliver executive-level reporting on payor performance, ERA utilization, denial trends, and enrollment opportunities.
• Recommend operational changes to improve clean claim rates, accelerate payment posting, and reduce manual intervention.
• Process Optimization & Ownership
• Take ownership of end-to-end payor configuration lifecycle, from initial setup to ongoing maintenance, including validating payer IDs, submission services, enrollment status, and clearinghouse integration.
• Lead payor research efforts to maintain current and accurate data in the RPM platform, ensuring alignment with clearinghouse updates and evolving payor requirements.
• Drive the creation, refinement, and enforcement of standard operating procedures (SOPs) to ensure consistency and scalability in EDI/payor processes.
• Regulatory Compliance & Quality Assurance
• Ensure all EDI and payor activities adhere to HIPAA, CMS, and other applicable regulations.
• Conduct periodic audits of payor data and EDI transactions to maintain compliance and data integrity.
• Act as a compliance resource for internal teams on matters related to payor data, enrollments, and electronic transactions.
  
  
  

What you will bring to the team:

We’re looking for someone with a growth mindset and a passion for learning. You might be a great fit if you:

• Exceptional communication and negotiation skills with the ability to influence stakeholders.
• Strong analytical and problem-solving capabilities with keen attention to detail.
• Ability to manage projects independently and meet deadlines in a fast-paced environment.
• High proficiency in Microsoft Excel and other data analysis/reporting tools.
  
  
  

Skills and experience you have:

You don’t need to check every box. We will consider a combination of education and experience, including:

Education

• Bachelor’s degree in Healthcare Administration, Information Systems, Business, or a related field preferred (Associate degree minimum).
  
  
  

Experience

• 3–5 years in healthcare revenue cycle, billing, or payor relations, with direct EDI/X12 transaction experience.
• Demonstrated expertise in both lab and pharmacy billing and reimbursement processes. (preferred)
• Strong proficiency in SQL for data extraction, manipulation, and reporting.
• Proven track record of managing multiple payor relationships and delivering measurable results in claim performance improvement.
  
  
  

Why XiFin?

We’re more than just a healthcare technology company—we’re a team that cares about people.

Here’s a glimpse at what we offer:

• Comprehensive health benefits including medical, dental, vision, and telehealth
• 401(k) with company match and personalized financial coaching to support your financial future
• Health Savings Account (HSA) with company contributions
• Wellness incentives that reward your preventative healthcare activities
• Tuition assistance to support your education and growth
• Flexible time off and company-paid holidays
• Social and fun events to build community at our locations
  
  
  

Pay Transparency

At XiFin, we believe in pay transparency and fairness. The expected annual salary range for this role is $19.50 to $25.50, based on your experience, skills, and geographic location.

Final compensation will be determined during the selection process and may vary accordingly.

Accessibility & Accommodations

We’re committed to providing an inclusive and accessible experience for all applicants. If you need a reasonable accommodation during the application process, please contact us at 858-436-2901.

Equal Opportunity Employer

XiFin is proud to be an equal opportunity employer. We value diverse voices and do not discriminate on the basis of race, color, religion, national origin, gender, gender identity, sexual orientation, disability, age, veteran status or any other basis protected by law.

Ready to apply?

We’d love to hear from you—even if you’re not sure you meet every qualification. If you're excited about the role and believe you can contribute to our team, please apply. Let's build something meaningful together.