Position Overview:
The Payer Reimbursement Specialist is responsible for performing advanced Level 2 audits of payer contract loads, ensuring accuracy, compliance, and proper documentation across all centers. This role serves as a highly skilled technical resource, reviewing contract load accuracy. This position requires a seasoned A/R or reimbursement professional with strong managed care knowledge, exceptional organization, and the ability to work in a fast-moving, evolving environment.
Responsibilities:
- Perform SOX Level 2 audits to validate contract load accuracy.
- Review contract rate loads, contract types, MPRs, insurance carrier links, and contract grid updates.
- Identify and document discrepancies, coordinate corrections with Managed Care Finance Ops.
- Identify where contract grid updates are needed to communicate updates to payer reimbursement analysts, adding notes and ensuring accurate documentation for all audits.
- Utilize and maintain tracking systems; monitor audit status and follow-up needs.
- Assist in implementing improved tracking and workflow processes, including potential ticketing and intake solutions.
- Communicate regularly with Analysts, Managers, and contract loaders to resolve audit findings.
- Support special projects and other reimbursement initiatives.
- Additional responsibilities assigned as needed.
Required Skills:
Requirements:
- 3–5 years of experience in payer reimbursement, A/R management, or contract administration (ASC experience preferred).
- Strong understanding of managed care contracts, reimbursement methodologies, and payer loading processes.
- Experience with SOX audits or regulatory auditing preferred.
- Exceptional organization and tracking skills; ability to manage high-volume, detail-heavy workflows.
- Strong analytical skills with the ability to spot discrepancies and escalate appropriately.
- Ability to thrive in a fast-paced and changing environment; adaptable and quick learner.
- Proficiency in Excel and familiarity with systems such as SIS and AdvantX.
- Strong written and verbal communication skills.