Payer Compliance Specialist I

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

📋 Description

• Adhere to standard operating procedures for payer compliance management

• Assess, analyze, and confirm variances in payer allowances within work queues

• Handle corrective measures through appeals, cross-workflow processes, or escalate issues to management

• Collect documentation for appeals and submit them to payers

• Follow up on the outcomes of appeals 45–60 days after they have been submitted

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

• Utilize the out-of-model guidance matrix to inform leadership and finance about over-allowed variances

• Acquire knowledge of payer policies and contractual agreements

• Investigate and address refund requests appropriately

• Consult with leadership and contract management regarding possible discrepancies in contract terms

• Maintain regular communication with management concerning payer variance matters

• Occasionally stand and walk, frequently sit, move hands and fingers, and use office equipment while communicating both verbally and in writing

⛳️ Requirements

• High school diploma or equivalent is mandatory

• At least 2 years of experience in the healthcare revenue cycle is required

• Proficiency in Excel and Word is essential

• Basic understanding of managed care programs and healthcare billing requirements

• Strong analytical skills to identify and address underpayments related to specific payers and coding issues

• Good mathematical, verbal, and written communication abilities

• Experience in gathering and reporting data

• A team-oriented mindset with strong interpersonal skills

• Capacity to work autonomously with minimal supervision

• Preferred familiarity with basic medical terminology and concepts

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

• Must reside in the United States, excluding California, Hawaii, and Alaska

🏝️ Benefits

• Eligibility for quarterly bonuses (not guaranteed; contingent on company and individual performance)

• Reasonable accommodations for individuals with disabilities

• Equal employment opportunities