Payer Compliance Specialist I – Remote

Specialist

Remote

August 14, 2026

Application ends: November 11, 2026

REQUIREMENTS

High school graduate or equivalent required.
Minimum of 2 years experience in healthcare revenue cycle.
Functional knowledge of Excel and Word required.
Basic knowledge of managed care programs and healthcare billing requirements necessary.
Analytical abilities to identify and resolve underpayments relating to specific payers, coding issues, etc. are required.
Good mathematical, verbal, and written communication skills.
Experience gathering and reporting information.
Must display a teamwork attitude and possess good interpersonal skills.
Ability to work independently with limited supervision.
Familiarity with basic medical terminology and concepts preferred.
Knowledge of CPT, ICD-9, and ASA coding preferred.

RESPONSIBILITES

Follows the payer compliance management standard operating procedures.
Analyzes, evaluates, and validates payer under and over-allowable variances in work queues.
Manages corrective actions to resolve the variances via appeal, cross-workflow, or escalation to management.
Gathers appeal documentation and files the appeal to various payers as appropriate.
Follows up on appeal results 45-60 days post appeal submission.
Partners with leadership to research and report payer systemic issues creating variance trends.
Uses the out-of-model guidance matrix to assist with accurately and consistently reporting over-allowed variances to leadership and finance.
Learns and familiarizes payer policies and contractual terms associated with the payer to which the analyst is assigned.
Researches refund requests sent via correspondence cross-workflow, appropriately responds, and/or takes action.
Inquires with leadership and the contract management team on potential contract term discrepancies.
Communicates regularly with the management team regarding payer variance issues.