Payer Contracting Specialist

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Take ownership of provider data accuracy across all systems.

• Conduct audits of provider listings in payer directories and initiate necessary corrections.

• Regularly reconcile provider rosters with payer records on an ongoing basis.

• Act as the primary contact for enrollment and provider-data issues.

• Collaborate with the Revenue Cycle team to address denials and determine root causes.

• Investigate and interpret payer policies, including medical policy bulletins, telehealth and virtual care regulations, prior authorization requirements, fee schedules, and provider manuals.

• Find and keep track of executed agreements, amendments, rosters, W9s, and welcome letters.

• Record payer requirements and resolved escalations in reliable internal references.

• Assist in contracting and credentialing by preparing, submitting, and tracking payer applications for new health plan collaborations and service lines.

• Offer additional support for follow-ups, deficiency resolutions, revalidations, and trackers.

⛳️ Requirements

• Minimum of 2 years in provider data management, revenue cycle, denials, payer operations, credentialing, or healthcare administration; relevant internship or adjacent RCM experience is acceptable.

• Must be genuinely self-directed.

• Enjoys researching and understanding payer policies and requirements.

• Possess a root-cause analysis mindset.

• Exceptional attention to detail is essential.

• Comfortable communicating over the phone with payers.

• Proficient in spreadsheets and quick to learn new systems and payer portals.

• Able to navigate ambiguity and shifting priorities in a dynamic, remote-first environment.

• Capable of documenting solutions and processes effectively.

• Hands-on experience with payer portals and clearinghouses like Availity is preferred.

• Experience in ensuring provider directory accuracy, roster submissions, or demographic data management is preferred.

• Background in denial management or accounts receivable follow-up is preferred.

• Familiarity with commercial payer requirements; experience with Medicare and Medicaid is an advantage.

• Preferred experience in multi-state telehealth, digital health, or rapidly growing healthcare environments.

• Exposure to credentialing standards such as NCQA and CMS is preferred.

• Working knowledge of CPT/ICD-10 and modifiers; certification is not required.

🏝️ Benefits

• Equity.

• Professional development and employee learning programs.

• Comprehensive health benefits (medical, dental, vision).

• Generous paid time off.

• Additional wellness and professional development perks.

• 100% remote work within the U.S.

• Unlimited PTO.

• 11 company holidays.

• Health Savings Account (HSA).

• Flexible Spending Account (FSA).

• Long- and short-term disability coverage.

• Annual employee wellness stipend.

• 401(k) plan.

• Parental leave.

• Family planning support benefits.

• Company-issued laptop.

• Annual work-from-home stipend.

• Commuter benefits (if applicable).

• Opportunities for advancement.

• A collaborative, mission-driven culture focused on enhancing patient care.