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Payer Contracts Administrator (REMOTE OPPORTUNITY)
$53,600 - $77,800/Yr
Breg - Carlsbad, CA
posted 2 months ago
Full-time - Mid Level
Remote - Carlsbad, CA
Merchant Wholesalers, Durable Goods
About the position
The Payor Contracts Administrator is a full-time remote position responsible for reviewing, revising, and analyzing payor contracts. This role requires a proactive individual who can manage multiple tasks in a fast-paced environment while ensuring compliance with contractual obligations. The administrator will serve as a Subject Matter Expert in Payor Contracts Administration, supporting leadership with reporting and maintaining accurate databases related to insurance payors.
Responsibilities
- Maintains and validates the Insurance Payor Databases.
- Initiates requests to contract.
- Reviews contract language and pricing requests for approval by the Director, Payor Contracts.
- Assists with appropriate changes to proposals and/or contracts as directed.
- Reviews Insurance Contracts to preclude inconsistencies in pricing, claim submission, medical policies and reimbursement procedures.
- Completes credentialing applications and provides supporting documentation to maintain and/or secure the payor contract or enrollment with a State agency.
- Ensures that all claims submission guidelines are uploaded and/or implemented into the appropriate databases.
- Maintains the standard insurance database information for current listings or additions as requests are received.
- Reviews updated in-house insurance reports to verify billing information and validate pricing.
- Maintains thorough communication with on-shore and off-shore billing teams regarding the payor database.
- Supports the Central Billing Office with claims processing set-ups including EDI, EFT and ERN.
Requirements
- Bachelor's degree preferred.
- 2+ years' experience processing payor contracts and agreements.
- Familiarity with Healthcare reimbursement regulations.
- Proficient in Microsoft Office, including Advanced Excel and PowerPoint.
- Ability to learn new software and systems.
Benefits
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- Paid time off (PTO)
- Paid holidays
