Healthcare Payer Compliance Specialist - 100% Remote

Expressable

23d • $24 - $27 • Remote

About The Position

The Payer Compliance Specialist ensures adherence to payer requirements and internal compliance standards by supporting a claim-ready environment across operational teams; driving audit readiness, reducing denials, and improving claim resolution through proactive communication, process review, and cross-functional collaboration.

Requirements

• Associate’s or Bachelor’s degree in healthcare administration, business, or a related field (or equivalent work experience).
• 3+ years of experience in medical billing, revenue cycle operations, payer compliance, or healthcare auditing.
• Familiarity with payer contracts, reimbursement policies, and healthcare documentation standards.
• Proficiency with practice management systems, payer portals, and claims processing tools.
• Experience managing EFT/ERA setup, fee schedules, and provider enrollment data.
• Strong spreadsheet and document management skills (e.g., Google Workspace or Microsoft Office).
• Analytical - Strong analytical and critical thinking skills to interpret payer policies and identify operational impacts.
• Communication - Effective verbal and written communication skills, including the ability to deliver training and simplify complex topics.
• Collaboration - Ability to collaborate cross-functionally with billing, clinical, and compliance teams in a fully remote environment.
• Adaptability - Adaptability to evolving payer requirements and healthcare regulations.

Responsibilities

• Support audit and compliance efforts by assisting with external payer responses, conducting internal reviews, and ensuring required training is completed.
• Maintain payer setup and readiness including fee schedules, EFT/ERA configuration, portal access, and payer profile updates.
• Interpret payer contracts and manuals to extract operational requirements and support clean claim submission.
• Maintain up-to-date reference materials and serve as a resource to internal teams on payer rules and workflows.
• Monitor payer updates and policy changes, assess their impact, and assist with implementation and compliance tracking; attending new payer orientation meetings and ongoing payer training sessions.
• Collaborate cross-functionally on special projects to improve payer compliance, documentation, and training systems.

Benefits

• Exceptional paid time off policies that encourage and support life balance, including a winter break.
• 401k matching to ensure our staff have what they need to enjoy their retirement
• Health insurance options that ensure well being for the whole person and their family
• Company paid life, short-term disability, and long-term disability coverage
• Remote work environment that strives for connectivity through professional collaboration and personal connections

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree