Payer Compliance Specialist

Job Summary

Analyzing allowed amounts on claims, the full-time remote Payer Compliance Specialist will review variances, appeal for re-processing, and resolve payer issues to ensure compliance with contracts.

Key responsibilities

• Analyze and validate payer variances in work queues, managing corrective actions as needed
• Gather and file appeal documentation with payers, following up on results within 45-60 days
• Collaborate with leadership to identify and report systemic payer issues affecting receivables

Required qualifications

• High school diploma or equivalent required
• Minimum of 2 years of experience in healthcare revenue cycle
• Functional knowledge of Excel and Word
• Basic understanding of managed care programs and healthcare billing requirements
• Familiarity with medical terminology and coding (CPT, ICD-9, ASA) preferred