Healthcare Payer Operations Specialist

Healthcare Payer Operations Specialist

Location:


Fully Remote

Compensation:


$67,000 - $75,000 annually

Schedule:


Monday-Friday, 8:00 AM-4:30 PM

About the Opportunity

Our client is a mission-driven healthcare organization dedicated to improving the lives of individuals with disabilities. They are seeking a detail-oriented and analytical


Payer Operations Specialist


to support payer contracting, audit management, reimbursement analysis, compliance, and operational process improvement.

This role offers the opportunity to work cross-functionally with internal teams while managing payer relationships, resolving complex reimbursement issues, and ensuring compliance with healthcare regulations.

Key Responsibilities

• 
  Manage payer audits, including post-audit appeals and dispute resolution.
  
  



• 
  Research and resolve payer policy, documentation, pricing, and reimbursement discrepancies.
  
  



• 
  Support payer contracting activities, onboarding, revalidations, and document audits.
  
  



• 
  Investigate and resolve contract pricing and claims variances.
  
  



• 
  Utilize Salesforce to track cases, contracts, escalations, and reporting.
  
  



• 
  Review payer contracts and policies for compliance with HIPAA, CMS, and state regulations.
  
  



• 
  Partner with internal departments to identify solutions and implement corrective actions.
  
  



• 
  Ensure documentation meets payer requirements and compliance standards.
  
  



• 
  Improve workflows, contract tracking processes, and operational efficiencies.
  
  



• 
  Build and maintain positive relationships with payer representatives.
  
  



• 
  Stay informed on healthcare regulations, reimbursement trends, and payer requirements.
  
  

Qualifications

• 
  Bachelor's degree in Healthcare Administration, Business, Finance, or related field.
  
  



• 
  3+ years of experience in payer operations, managed care, healthcare policy analysis, or related healthcare environments.
  
  



• 
  Experience handling denials, appeals, grievances, redeterminations, audits, and post-audit responses.
  
  



• 
  Knowledge of Medicare, Medicaid, and commercial payer reimbursement methodologies.
  
  



• 
  Experience supporting payer contracts and resolving pricing discrepancies.
  
  



• 
  Proficiency with Salesforce for case management, workflow tracking, reporting, and dashboards.
  
  



• 
  Strong understanding of HIPAA, CMS, and healthcare compliance regulations.
  
  



• 
  Excellent analytical, problem-solving, communication, and collaboration skills.
  
  



• 
  Ability to manage multiple priorities in a fast-paced environment.
  
  

Why Consider This Role?

? Fully remote work environment

Benefits During Contract Assignment

Eligible employees may have access to:

• 
  Medical coverage
  
  



• 
  Dental and vision insurance
  
  



• 
  Hospital indemnity coverage
  
  



• 
  Accident and critical illness coverage
  
  



• 
  Life insurance
  
  



• 
  Short-term disability
  
  



• 
  Employee discount programs
  
  



• 
  Earned safe and sick time where applicable
  
  
  
  

Benefits Upon Permanent Hire

• 
  Employer-paid medical premium assistance
  
  



• 
  Generous PTO and paid holiday package
  
  



• 
  401(k) employer contribution
  
  



• 
  Tuition reimbursement
  
  



• 
  Student loan repayment assistance
  
  



• 
  Cell phone and internet reimbursement
  
  



• 
  Holiday and year-end bonus opportunities
  
  

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, Los Angeles County Fair Chance Ordinance, and San Francisco Fair Chance Ordinance.