Payer Contract Specialist

United Surgical Partners International; Dallas (TX); On-site; USD 60,000 - 80,000; Full time

Job summary

United Surgical Partners International in Dallas is seeking a Payer Contract Specialist to coordinate with managed care and execute contract changes effectively. This role involves maintaining payer databases, reviewing contracts, and troubleshooting issues to ensure timely reimbursements.

The ideal candidate should have strong communication skills, be detail-oriented, and possess some knowledge of claims processing and EDI files. Join a dynamic team where you can make an impact.

Qualifications

• Detail-oriented and organized, capable of managing multiple projects.
• Experience in a fast-paced environment and effective communication across mediums.

Responsibilities

• Update and maintain payer grids database.
• Review contract files for data accuracy.
• Enroll and maintain access with payers for electronic transactions.
• Assist with current billing documentation for health plans.
• Troubleshoot user portal issues.

Skills

Claims processing knowledge

Familiarity with EDI files

Data analysis

Communication skills

Job description

Position Overview:

The Payer Contract Specialist will coordinate with managed care to communicate and implement contract changes. Collaborate with facilities and healthcare payers to execute enrollments, manage, and maintain proprietary systems, provide documentation maintenance, and monitor communication from payers. They will maintain administrative rights and set up new access. The Payer Contract Specialist proactively works with payers, in-house staff, and vendor resources to identify and resolve issues that hinder optimal & timely reimbursement.

Responsibilities:

• In coordination with managed care, update and maintain payer grids database of contracted health plans and communicate regular updates to the operations teams regarding network changes.
• Review contract files for accuracy of data entry of contract specifications and terms into database and vendor programs.
• Review and respond to any escalated network issues from operations teams to managed care to identify and resolve root cause.
• Accurately enroll and maintain access with payers for ERA, EFT, and web portals across the enterprise.
• Review paper correspondence for opportunities to convert to electronic methods.
• Assist facilities with providing current facility billing documentation to health plans and other entities.
• Create and maintain internal and external portal guides and documentation for features utilized by CSO.
• Add, maintain, update, and apply accurate permissions for CSO and vendor users on payer web portals.
• Troubleshoot and resolve external or internal user portal issues.
• Communicates with facility administrators for CSO access to existing portals.
• Coordinate with EHR/RIS Team on nThrive EDI transactions (837, 835, 270/271).
• Works with automated processes, SFTP transfers, and security.
• Additional operational activities including report generation.
• Special projects as required to support CSO/RCM teams.

Required Experience:

• Experience with hospital claims processing preferred but not required.
• Experience with EDI files and transactions are preferred.
• General knowledge of Insurance and employee health plan administration.
• Must be able to handle a wide variety of work in a fast-paced environment.
• Must be detail oriented, organized, self-starter, and have an ability to prioritize workload.
• Ability to analyze and interpret data and solve practical problems in independent and team environments.
• Must be able to communicate well across all mediums.
• Ability to work under deadlines and manage multiple projects.