Payment Compliance and Contracts Specialist

Community Health Systems

2h

About The Position

The Payment Compliance & Contract Management (PCCM) Specialist serves as a subject matter expert and team lead, responsible for maximizing reimbursement through the identification of revenue opportunities and resolution of contractual variances. This role oversees quality assurance and performance management processes, providing guidance to team members and allocating workloads effectively. This role also involves analyzing reimbursement discrepancies, providing strategic insights, and collaborating with internal and external stakeholders to improve revenue cycle processes.

Requirements

• Bachelor's Degree or equivalent work experience on a year-for-year basis required
• 3-5 years of experience in healthcare reimbursement, contract management, or revenue cycle operations required
• Demonstrated expertise in analyzing and interpreting payer contracts and reimbursement methodologies required
• Strong analytical and data interpretation skills.
• Advanced understanding of healthcare reimbursement systems and payer contracts.
• Excellent leadership and team collaboration abilities.
• Effective communication and presentation skills.
• Proficiency in data analysis tools and healthcare billing software.
• High attention to detail and ability to manage multiple priorities.

Responsibilities

• Conducts quality monitoring to ensure team performance meets departmental metrics, and provides actionable recommendations to senior leadership when KPIs are not achieved.
• Trains and mentors staff to ensure team efficiency and compliance with departmental standards.
• Manages, maintains, and directs key technologies administered by the department to support payment compliance and contract management activities.
• Analyzes workload demands through data analysis, assigning tasks to team members based on priorities and department needs.
• Identifies opportunities for process improvement and collaborates with external organizations to enhance payment integrity and optimize contract modeling.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level