Payer Contract Specialist

Position Overview:

The Payer Contract Specialist will coordinate with managed care to communicate and implement contract changes. Collaborate with facilities and healthcare payers to execute enrollments, manage, and maintain proprietary systems, provide documentation maintenance, and monitor communication from payers. They will maintain administrative rights and set up new access. The Payer Contract Specialist proactively works with payers, in-house staff, and vendor resources to identify and resolve issues that hinder optimal & timely reimbursement.

Responsibilities:

• In coordination with managed care, update and maintain payer grids database of contracted health plans and communicate regular updates to the operations teams regarding network changes.
• Review contract files for accuracy of data entry of contract specifications and terms into database and vendor programs.
• Review and respond to any escalated network issues from operations teams to managed care to identify and resolve root cause.
• Accurately enroll and maintain access with payers for ERA, EFT, and web portals across the enterprise.
• Review paper correspondence for opportunities to convert to electronic methods.
• Assist facilities with providing current facility billing documentation to health plans and other entities.
• Create and maintain internal and external portal guides and documentation for features utilized by CSO.
• Add, maintain, update, and apply accurate permissions for CSO and vendor users on payer web portals.
• Troubleshoot and resolve external or internal user portal issues.
• Communicates with facility administrators for CSO access to existing portals.
• Coordinate with EHR/RIS Team on nThrive EDI transactions (837, 835, 270/271).
• Works with automated processes, SFTP transfers, and security.
• Additional operational activities including report generation.
• Special projects as required to support CSO/RCM teams.

• Experience with hospital claims processing preferred but not required.
• Experience with EDI files and transactions are preferred.
• General knowledge of Insurance and employee health plan administration.
• Must be able to handle a wide variety of work in a fast-paced environment.
• Must be detail oriented, organized, self-starter, and have an ability to prioritize workload.
• Ability to analyze and interpret data and solve practical problems in independent and team environments.
• Must be able to communicate well across all mediums.
• Ability to work under deadlines and manage multiple projects.