Payer Compliance Specialist - Remote

Overview

The 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.
• Maintain payer setup and readiness including fee schedules and portal access.
• Interpret payer contracts to support clean claim submission.
• Maintain up-to-date reference materials for internal teams.
• Monitor payer updates and policy changes, assisting with implementation.
• Collaborate cross-functionally on projects to improve payer compliance.

Requirements

• Associate’s or Bachelor’s degree in healthcare administration or related field.
• 3+ years of experience in medical billing or healthcare auditing.
• Familiarity with payer contracts and reimbursement policies.
• Proficiency with practice management systems and claims processing tools.
• Experience managing EFT/ERA setup and provider enrollment data.
• Strong spreadsheet and document management skills.

Benefits

• Exceptional paid time off policies.
• 401k matching for retirement.
• Health insurance options for employees and families.
• Company paid life and disability coverage.
• Remote work environment promoting connectivity.