Revenue Integrity & Contract Optimization Specialist

Community Health Systems; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Comprehensive Health Coverage

401(k) with matching

Student Loan Support

Educational Tuition Assistance

Competitive pay & full benefits

Job summary

Community Health Systems is seeking a Payment Compliance & Contract Management (PCCM) Specialist to enhance reimbursement accuracy by reviewing outcomes, identifying discrepancies, and resolving variances between expected and actual payments.

The role involves evaluating contract terms, payer behavior, and claim activity, addressing underpayments and denials, and partnering with internal teams and payers to maintain compliant revenue-cycle operations.

Qualifications

• H.S. Diploma or GED required.
• Associate Degree in Business, Healthcare Administration, or related field preferred
• 3-5 years of experience in healthcare revenue cycle, reimbursement, or related field required
• 1-3 years of experience working with payer contracts, claims, denials, or appeals processes required
• Experience with healthcare billing systems and data tools preferred
• Experience working in a multi-facility or shared services environment preferred

Responsibilities

• Reviews reimbursement outcomes to identify underpayments, overpayments, denials, and revenue leakage.
• Investigates payment discrepancies and resolves issues through account follow-up, appeals, and payer communication.
• Evaluates contract terms and payer policies to determine expected reimbursement and validate payment accuracy.
• Supports identification of trends in reimbursement issues and escalates findings to appropriate stakeholders.
• Compiles and organizes data related to payment discrepancies and resolution activities.
• Collaborates with revenue cycle, finance, and clinical teams to address reimbursement issues and support process improvements.
• Reviews contract configurations and payer updates to support accurate reimbursement processes.
• Communicates findings and resolution status to internal stakeholders and leadership as needed.
• Maintains documentation of issues, actions taken, and outcomes to support reporting and process improvement efforts.

Skills

Healthcare reimbursement knowledge

Payer contract experience

Data analysis & reporting

Stakeholder communication

Multitasking in a fast-paced env

Education

High School Diploma or GED

Associate degree in Business or Healthcare Administration (preferred)

Job description

Community Health Systems is seeking a Payment Compliance & Contract Management (PCCM) Specialist to enhance reimbursement accuracy by reviewing outcomes, identifying discrepancies, and resolving variances between expected and actual payments.

The role involves evaluating contract terms, payer behavior, and claim activity, addressing underpayments and denials, and partnering with internal teams and payers to maintain compliant revenue-cycle operations.