Payer Compliance Lead — Revenue Cycle Optimizer

Kpc Global Medical Centers Inc.; Santa Ana (CA); On-site; USD 103,155,000 - 126,078,000; Full time

Job summary

KPC SANTA ANA is seeking a Senior Payer Compliance Specialist to ensure adherence to payer requirements and reimbursement best practices on-site in Santa Ana, CA. The role focuses on auditing accounts, identifying trends, and guiding process improvements to maximize reimbursement and reduce denials.

You will collaborate with leadership and cross-functional teams, provide staff support, and help drive regulatory compliance across the revenue cycle.

Qualifications

• High school diploma or equivalent is required.
• Minimum of 5 years in hospital revenue cycle, A/R, billing, denials, or reimbursement.
• Experience with commercial, managed care, workers' comp, and government payers is preferred.

Responsibilities

• Resolve accounts within established productivity and quality standards.
• Audit patient accounts for compliance with payer guidelines, contracts, billing regulations, and internal policies.
• Review accounts to identify compliance risks, reimbursement opportunities, and process gaps.
• Analyze underpayments, denials, payment variances, and reimbursement discrepancies.
• Monitor payer performance and trends affecting reimbursement and collections.
• Escalate reimbursement and compliance concerns to leadership; coordinate with regulatory agencies as needed.
• Prepare month-end payer trend reports and action plans.

Skills

Payer compliance

Revenue cycle

Analytical skills

Excel

Communication

Education

High school diploma or equivalent

Tools

A/R reporting

Payer contract interpretation

Job description

KPC SANTA ANA is seeking a Senior Payer Compliance Specialist to ensure adherence to payer requirements and reimbursement best practices on-site in Santa Ana, CA. The role focuses on auditing accounts, identifying trends, and guiding process improvements to maximize reimbursement and reduce denials.

You will collaborate with leadership and cross-functional teams, provide staff support, and help drive regulatory compliance across the revenue cycle.