Medical Billing- Payer Strategy & Contracting Specialist
Location
United States
Posted
5 days ago
Salary
Not specified
Job Description
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.
Benefits
- 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.
Job Requirements
- 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.
- 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.
Benefits
- 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.
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