Payer Compliance Specialist

Job Summary

Analyzing allowed amounts for claims, the full-time Payer Compliance Specialist will review variances, manage appeals for re-processing, and resolve payer issues impacting receivables in a remote environment.

Key responsibilities

• Analyze and validate payer under and over-allowable variances in work queues
• Manage corrective actions for variances through appeals and escalate issues to management as needed
• Communicate regularly with management regarding payer variance issues and report systemic trends

Required qualifications

• 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
• Familiarity with basic medical terminology and concepts preferred