Payment Compliance & Contract Management Specialist (REMOTE)
About The Position
The Payment Compliance & Contract Management (PCCM) Specialist supports reimbursement accuracy by reviewing payment outcomes, identifying discrepancies, and resolving variances between expected and actual reimbursement. This role evaluates contract terms, payer behavior, and claim activity to address underpayments, denials, and revenue opportunities. The PCCM Specialist partners with internal teams and external payers to resolve issues and support efficient, compliant revenue cycle operations. The Payment Compliance and Contract Management (PCCM) team plays a critical role in ensuring that payments are made according to contractual agreements and regulatory requirements. The team oversees the full contract lifecycle, focusing on analyzing reimbursement discrepancies, improving revenue cycle processes, and ensuring compliance with contract terms to support financial accuracy and operational efficiency.
Requirements
- H.S. Diploma or GED required
- 3-5 years of experience in healthcare revenue cycle, reimbursement, or related field required
- 1-3 years of experience working with payer contracts, claims, denials, or appeals processes required
- Strong understanding of healthcare reimbursement processes, payer contracts, and claims workflows.
- Ability to investigate discrepancies and determine appropriate resolution steps.
- Effective communication skills to coordinate with internal teams and external payer representatives.
- Ability to manage multiple priorities and maintain accuracy in a fast-paced environment.
- Strong attention to detail and organization in tracking and resolving payment issues.
Nice To Haves
- Associate Degree in Business, Healthcare Administration, or related field preferred
- Experience with healthcare billing systems and data tools preferred
- Experience working in a multi-facility or shared services environment preferred
Responsibilities
- Reviews reimbursement outcomes to identify underpayments, overpayments, denials, and revenue leakage.
- Investigates payment discrepancies and resolves issues through account follow-up, appeals, and payer communication.
- Evaluates contract terms and payer policies to determine expected reimbursement and validate payment accuracy.
- Supports identification of trends in reimbursement issues and escalates findings to appropriate stakeholders.
- Compiles and organizes data related to payment discrepancies and resolution activities.
- Collaborates with revenue cycle, finance, and clinical teams to address reimbursement issues and support process improvements.
- Reviews contract configurations and payer updates to support accurate reimbursement processes.
- Communicates findings and resolution status to internal stakeholders and leadership as needed.
- Maintains documentation of issues, actions taken, and outcomes to support reporting and process improvement efforts.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
Benefits
- Comprehensive Health Coverage – Medical, dental, and vision plans to keep you and your family healthy.
- Future Security: 401(k) with matching
- Student Loan Support – Up to $10,000 repayment assistance, because we invest in your future.
- Educational Tuition Assistance
- Competitive Pay & Full Benefits – A salary and package designed to reward your expertise and dedication.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
