Payer Contracts & Reimbursement Specialist

United Surgical Partners International, Inc; Dallas (TX); On-site; USD 60,000 - 90,000; Full time

Job summary

United Surgical Partners International, Inc. is seeking a Payer Contract Specialist to coordinate with managed care, implement contract changes, and ensure timely reimbursement across facilities and payers.

The role involves maintaining payer grids, enrolling payers for ERA/EFT, and resolving network issues with internal teams and vendors. Responsibilities include updating data entry accuracy for contract terms, converting paper to electronic communications, and creating guides for CSO portal

Qualifications

• Experience with hospital claims processing preferred but not required.
• Experience with EDI files and transactions 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.

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.

Skills

Hospital claims processing

EDI transactions

Data analysis

Deadline-driven

Job description

United Surgical Partners International, Inc. is seeking a Payer Contract Specialist to coordinate with managed care, implement contract changes, and ensure timely reimbursement across facilities and payers.

The role involves maintaining payer grids, enrolling payers for ERA/EFT, and resolving network issues with internal teams and vendors. Responsibilities include updating data entry accuracy for contract terms, converting paper to electronic communications, and creating guides for CSO portal