Healthcare Payer Compliance Specialist - Remote

Overview

The Healthcare Payer Compliance Specialist ensures adherence to payer requirements and internal compliance standards by supporting a claim-ready environment across operational teams; driving audit readiness, reducing denials, and improving claim resolution through proactive communication, process review, and cross-functional collaboration.

In Short

• Support audit and compliance efforts by assisting with external payer responses and conducting internal reviews.
• Maintain payer setup including fee schedules, EFT/ERA configuration, and payer profile updates.
• Interpret payer contracts and manuals to support clean claim submission.
• Serve as a resource to internal teams on payer rules and workflows.
• Monitor payer updates and policy changes, assessing their impact.
• Collaborate cross-functionally to improve payer compliance and documentation.

Requirements

• Associate’s or Bachelor’s degree in healthcare administration, business, or a related field.
• 3+ years of experience in medical billing, revenue cycle operations, or healthcare auditing.
• Familiarity with payer contracts and reimbursement policies.
• Proficiency with practice management systems and claims processing tools.
• Strong spreadsheet and document management skills.

Benefits

• Exceptional paid time off policies.
• 401k matching.
• Health insurance options.
• Company paid life and disability coverage.
• Remote work environment.