Revenue Specialist

Payer Revenue Integrity Specialist

Central Billing Office | Bethesda, MD (In-Office/On-Site)

Target Compensation - $30-$32 per hour ($62,000-$65,000) bonus

Our client—one of the nation’s largest and most respected physician-owned orthopedic groups, with more than 60 locations in MD, DC & VA—is seeking a Payer Revenue Integrity Specialist to join its Central Billing Office. This highly analytical role is responsible for ensuring payer reimbursements are accurate, compliant, and optimized in accordance with contract terms, healthcare regulations, and payer policies.

Reporting to the Director of Billing Operations, the specialist will perform in-depth analysis of payer contracts, reimbursement methodologies, and payment data to identify discrepancies, recover underpayments, reduce denials, and support revenue optimization initiatives.

Key Responsibilities

• Conduct comprehensive audits of payer reimbursements to ensure compliance with contractual terms and negotiated rates
• Analyze complex reimbursement methodologies, including fee-for-service, bundled payments, capitation, and alternative payment models
• Investigate and resolve payment discrepancies, underpayments, and denials through detailed data analysis and payer collaboration
• Maintain and update payer contract databases, fee schedules, and reimbursement terms
• Partner with billing and coding teams to ensure accurate charge capture and claim submission aligned with payer requirements
• Develop and implement data-driven strategies to maximize reimbursement and minimize denials
• Prepare detailed reports and analyses for leadership, highlighting trends, risks, and revenue opportunities
• Stay current on federal and state regulations, payer policies, and industry changes impacting reimbursement
• Educate and train internal staff on payer contracts, reimbursement processes, and compliance standards
• Support payer contract negotiations by providing analytical insight and reimbursement data
• Ensure strict adherence to HIPAA and all applicable healthcare laws and regulations
• Work directly with payers to obtain, validate, and maintain fee schedules

Qualifications & Requirements

• High School Diploma or equivalent required
• Certified Professional Coder (CPC) preferred
• Minimum 3 years of experience in a medical billing office
• Minimum 3 years of experience auditing payer payments and working with payer contracts
• Minimum 3 years of experience using contract management software
• Strong understanding of healthcare reimbursement methodologies, payer contracts, and federal/state regulations
• Experience with both commercial and government payers across billing and accounts receivable functions
• Working knowledge of medical billing practices, insurance benefits, and medical terminology
• Familiarity with CPT, HCPCS Level I and Level II coding systems
• Advanced proficiency with Microsoft Office, EMRs, practice management systems, and payer portals