Payer Contracting & Reimbursement Specialist

Mile-Bluff-Medical-Center-; Mauston (WI); On-site; USD 65,000 - 90,000; Full time

Job summary

Mile Bluff Medical Center is seeking a Payer Contracting Specialist to support the CFO in administering payer contracts, reimbursement analysis, and provider enrollment with insurance plans.

You will coordinate contract implementation, maintain the CDM, and monitor payer requirements, serving as a primary liaison across Administration, Patient Financial Services, and Clinical Departments to ensure accurate charging and reimbursement for Mile Bluff Medical Center services.

Qualifications

• Associate degree in Business Administration, Accounting, or Healthcare Administration preferred.
• Minimum three years of experience in healthcare finance, reimbursement, or related operations.
• Experience with Rural Health Clinics or rural healthcare organizations preferred.

Responsibilities

• Maintain payer contracts, amendments, fee schedules, reimbursement terms, and contract files.
• Track contract renewal dates, deadlines, and required updates.
• Coordinate initial enrollment, revalidation, demographic updates, and participation status for physicians, advanced practice providers, and other practitioners with commercial insurance plans and applicable government programs.
• Assist the CFO with payer contract negotiations by gathering reimbursement data, preparing contract comparisons, researching payer terms, and tracking negotiation activities and outcomes.
• Coordinate approved contract changes with billing, patient financial services, and other departments to ensure accurate system updates and appropriate reimbursement.
• Maintain and coordinate updates to the CDM, including charge descriptions, codes, pricing, and billing attributes, in collaboration with appropriate clinical, financial, and operational departments.
• Serve as a point of contact for routine payer inquiries related to contracts, provider enrollment, and participation status.
• Maintain accurate documentation, monitor enrollment and contract deadlines, and prepare reports or summaries for the CFO as requested.
• Monitor compliance with billing regulations and payer requirements.
• Support regulatory audits and documentation requests.
• Serve as the organization's primary administrator for Medicare PECOS activities. Maintain hospital, clinic, and provider enrollment records within PECOS.
• Maintain organizational and provider enrollment records within Wisconsin Forward Health.
• Coordinate Medicare, Medicaid, and Commercial payer revalidations, ownership updates, provider additions and deletions, practice location changes, and other enrollment actions.
• Perform other duties as requested.

Skills

Payer contracting

Reimbursement analysis

Excel proficiency

Revenue cycle

Contracts management

Healthcare finance

Education

Associate degree in Business Administration

Accounting

Healthcare Administration

Tools

PECOS

CDM systems

Job description

Mile Bluff Medical Center is seeking a Payer Contracting Specialist to support the CFO in administering payer contracts, reimbursement analysis, and provider enrollment with insurance plans.

You will coordinate contract implementation, maintain the CDM, and monitor payer requirements, serving as a primary liaison across Administration, Patient Financial Services, and Clinical Departments to ensure accurate charging and reimbursement for Mile Bluff Medical Center services.