Payer Reimbursement Specialist

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.

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.