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Role Description

Responsible for supporting payer contract development, analysis, and strategy execution to ensure optimal reimbursement and compliance with payer requirements.

• Conduct contract negotiation discussions on behalf of clients with payers
• Assist in reviewing, interpreting, and maintaining payer contracts and fee schedules
• Support negotiation preparation by compiling rate comparisons and reimbursement trends
• Identify and escalate contract discrepancies impacting payment performance
• Collaborate with finance and AR teams to ensure payer terms are accurately reflected in billing systems
• Maintain payer-related documentation, amendments, and communication logs
• Provide input for payer performance reviews and support audits as needed
• Participate in payer meetings or calls to support strategic initiatives

Qualifications

• High School Diploma or GED
• At least two to four (2-4) years of medical billing and claims resolution experience preferred
• AAHAM and/or HFMA certification preferred
• Experience with offshore engagement and collaboration desired

Requirements

• Strong understanding of payer contracts, reimbursement methodologies, and healthcare compliance
• Familiarity with commercial and government payers in the US healthcare system
• Proficiency with Excel, payer portals, and contract management databases
• Become proficient in the use of billing software within 4 weeks and maintain proficiency
• Ability to read, understand and apply state/federal laws, regulations, and policies
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner
• Ability to remain flexible and work within a collaborative and fast-paced environment
• Basic use of a computer, telephone, internet, copier, fax, and scanner
• Basic touch 10 key skills
• Basic Math skills
• Understand and comply with company policies and procedures
• Strong oral, written, and interpersonal communication skills
• Strong time management and organizational skills
• Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons
• This position is also eligible for a discretionary incentive bonus in accordance with company policies