Payment Compliance Specialist

Job Summary

Supporting reimbursement accuracy, the full-time remote Payment Compliance Specialist will review payment outcomes, identify discrepancies, and resolve variances between expected and actual reimbursement while collaborating with internal teams and external payers.

Key responsibilities

• Review reimbursement outcomes to identify underpayments, overpayments, denials, and revenue leakage
• Investigate payment discrepancies and resolve issues through account follow-up, appeals, and payer communication
• Evaluate contract terms and payer policies to determine expected reimbursement and validate payment accuracy

Required qualifications

• H.S. Diploma or GED required
• Associate Degree in Business, Healthcare Administration, or related field preferred
• 3-5 years of experience in healthcare revenue cycle, reimbursement, or related field required
• 1-3 years of experience working with payer contracts, claims, denials, or appeals processes required
• Experience with healthcare billing systems and data tools preferred