Payer Compliance Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee payer setup and readiness, including fee schedules, EFT/ERA configuration, portal access, and updates to payer profiles.

• Analyze payer contracts and manuals to derive operational requirements that facilitate clean claims submission.

• Track payer updates and policy modifications, evaluate their implications, and assist with implementation and compliance monitoring.

• Participate in new payer orientation meetings and ongoing training sessions with payers.

• Aid audit and compliance initiatives by supporting responses to external payer inquiries.

• Conduct internal assessments and ensure that necessary training is completed.

• Keep reference materials current and accessible.

• Act as a resource for internal teams regarding payer regulations and workflows.

• Collaborate across functions on projects aimed at enhancing payer compliance, documentation, and training systems.

⛳️ Requirements

• Associate's or Bachelor's degree in healthcare administration, business, or a related discipline (or equivalent professional experience).

• A minimum of 3 years of experience in medical billing, revenue cycle operations, payer compliance, or healthcare auditing.

• Experience in a healthcare environment is essential.

• Knowledge of payer contracts, reimbursement policies, and healthcare documentation standards is required.

• Medical Billing/Coding Certification is not mandatory but considered an advantage.

• Proficiency in practice management systems, payer portals, and claims processing tools.

• Experience in managing EFT/ERA setup, fee schedules, and provider enrollment information.

• Strong skills in spreadsheet and document management, utilizing tools like Google Workspace or Microsoft Office.

• Excellent analytical and critical thinking capabilities to interpret payer policies and recognize operational impacts.

• Strong verbal and written communication skills, with the ability to conduct training and clarify complex subjects.

• Ability to work collaboratively across functions in a fully remote setting.

• Flexibility to adapt to changing payer requirements and healthcare regulations.

• Must be eligible and legally authorized to work in the United States.

• Visa sponsorship is not offered.

🏝️ Benefits

• Outstanding paid time off policies that promote and support work-life balance.

• 401k matching.

• Options for health insurance.

• Company-sponsored life insurance.

• Company-funded short-term disability coverage.

• Company-funded long-term disability coverage.

• Fully remote working environment.

• Opportunities for professional collaboration and personal connection.