Payer Contract and Payment Specialist
Payer Contract and Payment Specialist
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Job Description
A career that changes lives.
SightMD is a rapidly growing integrated ophthalmic provider group extending the reach of exceptional eye care to patients across New York New Jersey Pennsylvania and Connecticut. With over 127 eye care providers and the convenience of 60 locations our commitment to delivering unparalleled services is at the heart of everything we do. As we embark on our mission we are actively seeking teammates who are eager to contribute to our legacy of eye excellence a tradition that spans more than 50 years.
Position Summary:
The Payer Contract & Payment Specialist will play a vital role in analyzing payer reimbursements to ensure they align with contractual agreements and fee schedules. This role plays a key part in identifying and recovering underpayments addressing discrepancies and supporting overall revenue integrity. Working collaboratively with internal departments and external payers the specialist ensures accurate payments contract compliance and contributes to continuous revenue cycle improvement.
Job Duties & Essential Functions:
- Analyze payer contracts and fee schedules to ensure compliance with negotiated terms.
- Identify trends in underpayments and discrepancies.
- Conduct contract and rate reviews for potential acquisitions.
- Provide detailed analysis to support business decisions.
- Maintain accurate and current payer fee schedules within the practice management system.
- Review payments for underpaid claims denials or incorrect adjustments.
- Initiate appeals resubmissions and negotiate reimbursement recovery.
- Compare payer remittances and EOBs against contracts to identify variances.
- Collaborate with payers to resolve any discrepancies.
- Communicate with insurance companies to dispute payments request corrections and escalate unresolved payment issues.
- Track underpayment cases and recovery actions.
- Generate reports to highlight payer trends contract compliance and financial impact.
- Work closely with billing payment posting and denial management teams to streamline claims processes and optimize revenue.
- Ensure all actions comply with federal state and payerspecific rules regarding claims and reimbursements.
- Identify workflow inefficiencies and suggest improvements to enhance underpayment recovery and revenue cycle operations.
- Special projects and other duties assigned.
Required Qualifications:
- Associates or Bachelors degree in Business Healthcare Administration or related field.
- Minimum 2 years in medical billing payer contract analysis or revenue cycle management.
- Strong analytical and problemsolving skills
- Experience with billing software and EHR systems
- Knowledge of payer reimbursement methodologies (e.g. FFS Medicare Medicaid managed care)
- Ability to interpret and apply contract language
- Excellent communication and negotiation abilities
- High attention to detail and time management
- Knowledge of HIPAA and healthcare industry regulations.
Preferred Qualifications:
- Experience with Six Sigma methodologies.
- Experience in ophthalmology or a specialty medical practice
- Knowledge of payerspecific policies and procedures
- Familiarity with medical terminology used in claims
- Certification in medical billing or coding (CPC CPB CRCR) is a plus
- Ability to manage multiple projects and priorities effectively
Work Schedule:
- Monday Friday
Hourly Pay Range:
- $26.00 $30.00/hour to commensurate with experience
Benefits:
We aim to take care of our teammates the same way we take care of our SightMD employees receive the following benefits:
- Medical/Dental/Vision Insurance
- Prescription Drug Coverage
- Company Paid Term Life Insurance & LongTerm Disability
- Supplemental Insurance Benefits
- Employee Assistance Program (EAP)
- Retirement Plan 401(k)
- Paid Time Off (PTO)
- Paid Holidays
- Career Development Programs
* All benefits are subject to eligibility requirements.
Equal Employment Opportunity Statement:
SightMD is an equal opportunity employer and does not discriminate on the basis of race color national origin religion creed age disability sex gender identity or expression sexual orientation familial status pregnancy predisposing genetic characteristics military status domestic violence victim status criminal conviction and all other protected classes under federal state and local laws.
If you are an individual with a disability and need a reasonable accommodation for any part of the application process or in order to perform the essential functions of a position please contact People Services at
Required Experience:
Unclear Seniority
Employment Type
Full-Time
