Payor Contract Specialist

The Payor Contract Specialist, under the guidance of the Sr. Health Plan Contract Analyst, plays a pivotal role in all aspects of payor contracting within the healthcare organization. With a focus on reimbursement analysis and contract management, this role ensures compliance, accuracy, and optimization of payor contracts. The ideal candidate possesses strong analytical skills, extensive knowledge of reimbursement principles, and exceptional communication abilities.

Responsibilities:

• Collaborate with the Senior Health Plan Contract Analyst to review and recommend changes to contract language and models.

• Maintain and update expected reimbursement systems and reporting structures.

• Resolve payor variance work queues through resubmission, appeals, or direct communication with payor representatives.

• Identify and address contract build issues in coordination with the Senior Analyst.

• Assist operations and billing departments in interpreting payor contracts and understanding reimbursement impacts.

• Support the Senior Analyst in program development initiatives and assess the financial impacts on various departments.

Position Qualifications:

• High School diploma required.

• Completion of online duty-specific training within 90 days of start date.

• Healthcare Financial Management Association (HFMA) Billing Certification completed within one year of hire date.

• Minimum of five (5) years of experience in reimbursement analysis.

• Experience with health plan and/or hospital reimbursement or finance required.

• Knowledge of CPT, ICD-10, and HCPCS coding structure required.

• Understanding of governmental agencies, commercial insurances, and state & county compliance guidelines preferred.

• Four to six years of previous experience as a financial analyst and/or auditor preferred.

Skills:

• Proficiency in reimbursement principles and payment methodologies, including Commercial, Medicare, and Medi-Cal.

• Understanding of hospital, home health, and professional billing systems, as well as government payment systems.

• Familiarity with computer systems including Microsoft Office, EPIC, and MedAssets Contract Manager.

• Strong analytical and problem-solving skills.

• Ability to manage multiple complex tasks efficiently.

• Advanced proficiency with Excel and Access software, including the ability to generate reports.

• Excellent written and oral communication skills, with the ability to present reports effectively.

• Capacity to operate multiple computer systems and software packages in a fast-paced environment.

• Ability to work with minimal supervision, reprioritize tasks as needed, and maintain excellent organizational and interpersonal skills.

Hybrid, 8am-5pm Monday-Friday

Pay Details: $50,000.00 to $60,000.00 per year

Search managed by: Joanna Calderon

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

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The Company will consider qualified applicants with arrest and conviction records subject to federal contractor requirements and/or security clearance requirements.