Payment Compliance & Contract Management Specialist (REMOTE)

NEC Unified Solutions; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

A leading company in healthcare solutions is seeking a Payment Compliance & Contract Management Specialist to enhance revenue cycle processes. This remote role involves overseeing quality assurance, training staff, and analyzing reimbursement discrepancies. Candidates should have a Bachelor's degree and 3-5 years of relevant experience, along with strong analytical and leadership skills.

Qualifications

• Bachelor's Degree or equivalent work experience required.
• 3-5 years in healthcare reimbursement or contract management required.
• Expertise in analyzing payer contracts and reimbursement methodologies.

Responsibilities

• Conduct quality monitoring and provide recommendations to leadership.
• Train and mentor staff for compliance and efficiency.
• Analyze workload demands and assign tasks based on priorities.

Skills

Analytical skills

Data interpretation

Leadership

Team collaboration

Communication

Attention to detail

Education

Bachelor's Degree

Tools

Healthcare billing software

Data analysis tools

Job description

Payment Compliance & Contract Management Specialist (REMOTE)

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Job Summary
The Payment Compliance & Contract Management (PCCM) Specialist (Remote) serves as a subject matter expert and team lead, responsible for maximizing reimbursement through the identification of revenue opportunities and resolution of contractual variances. This role oversees quality assurance and performance management processes, providing guidance to team members and allocating workloads effectively. The role also involves analyzing reimbursement discrepancies, providing strategic insights, and collaborating with internal and external stakeholders to improve revenue cycle processes.

Essential Functions

• Conducts quality monitoring to ensure team performance meets departmental metrics, and provides actionable recommendations to senior leadership when KPIs are not achieved.
• Trains and mentors staff to ensure team efficiency and compliance with departmental standards.
• Manages, maintains, and directs key technologies administered by the department to support payment compliance and contract management activities.
• Analyzes workload demands through data analysis, assigning tasks to team members based on priorities and department needs.
• Identifies opportunities for process improvement and collaborates with external organizations to enhance payment integrity and optimize contract modeling.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Bachelor's Degree or equivalent work experience on a year-for-year basis required
• 3-5 years of experience in healthcare reimbursement, contract management, or revenue cycle operations required
• Demonstrated expertise in analyzing and interpreting payer contracts and reimbursement methodologies required

Knowledge, Skills And Abilities

• Strong analytical and data interpretation skills.
• Advanced understanding of healthcare reimbursement systems and payer contracts.
• Excellent leadership and team collaboration abilities.
• Effective communication and presentation skills.
• Proficiency in data analysis tools and healthcare billing software.
• High attention to detail and ability to manage multiple priorities.