Payer Compliance Specialist I

This is a fully remote position, open to applicants in Alaska, +2 more states.

📋 Description

• Adhere to the standard operating procedures for payer compliance management.

• Assess, evaluate, and confirm payer variances that are under- or over-allowable in work queues.

• Oversee corrective measures via appeals, cross-workflow actions, or escalation to management.

• Collect appeal documentation and submit appeals to the appropriate payers.

• Follow up on the outcomes of appeals 45–60 days post-submission.

• Collaborate with leadership to investigate and report systemic payer issues that contribute to variance trends.

• Utilize the out-of-model guidance matrix to accurately and consistently report over-allowed variances to leadership and finance.

• Acquire and apply knowledge of payer policies and contractual agreements.

• Investigate refund requests, respond accordingly, and take necessary actions.

• Consult with leadership and the contract management team about possible discrepancies in contract terms.

• Maintain regular communication with management regarding payer variance challenges.

• Interact with internal RCM departments and insurance providers.

• Adhere to deadlines, management expectations, and manage multiple potentially stressful tasks.

⛳️ Requirements

• High school diploma or equivalent is required.

• At least 2 years of experience in healthcare revenue cycle is necessary.

• Proficient knowledge of Excel and Word is required.

• Basic understanding of managed care programs and healthcare billing requirements is essential.

• Strong analytical skills to identify and address payer-related underpayments and coding discrepancies.

• Good mathematical, verbal, and written communication abilities.

• Experience in gathering and reporting data.

• A collaborative attitude and strong interpersonal skills are important.

• Capability to work independently with minimal supervision.

• Familiarity with basic medical terminology and concepts is preferred.

• Knowledge of CPT, ICD-9, and ASA coding is preferred.

• Ability to meet physical demands with or without reasonable accommodation.

• Occasional standing and walking is required.

• Frequent sitting and hand/finger movement is necessary.

• Proficient in using office equipment and communicating both verbally and in writing.

• Candidates residing in California, Hawaii, or Alaska are not eligible for employment.

🏝️ Benefits

• Eligibility for quarterly bonuses.

• Equal employment opportunities are provided.

• Reasonable accommodations for individuals with disabilities are available.