Payor Relations Contract Compliance Specialist - PFS
About The Position
The Payor Relations Contract Compliance Specialist supports patient access and operational reliability by ensuring that payor contracts are accurately implemented, monitored, and maintained in compliance with regulatory and organizational standards. The role serves as a liaison between Kettering Health and external payors, analyzes contract terms, resolves compliance issues, and optimizes reimbursement processes. Other duties may be assigned. All job responsibilities are carried out in alignment with Kettering Health's mission, vision, values, and B Safe program. Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Its mission is to live God’s love by promoting and restoring health, and its commitment is to help individuals be their best. Safety is its top priority, and the system provides an integrated network of healthcare experts committed to exceptional care.
Requirements
- High school diploma or equivalent.
- At least 3 years of experience in payor relations, managed care contracting, contract compliance, or a similar role within a healthcare setting.
- Strong analytical and critical thinking skills.
- Proficiency in interpreting and analyzing contract language and reimbursement data.
- Effective verbal and written communication skills.
- Ability to collaborate with internal and external stakeholders.
- Working knowledge of healthcare regulations, such as HIPAA.
- Proficiency with Microsoft Office Suite and contract management systems.
- Attention to detail.
- Ability to prioritize and manage multiple projects.
Nice To Haves
- Associate's degree in Healthcare Administration, Business, or a related field, or an equivalent combination of education and experience.
- 5 or more years of experience in healthcare payor contracting, contract analysis, or revenue cycle management.
- Certification in healthcare compliance, such as CHC, AAHAM, or HFMA.
Responsibilities
- Ensure payor contracts are accurately implemented, monitored, and maintained in compliance with regulatory and organizational standards.
- Serve as a liaison between Kettering Health and external payors.
- Analyze contract terms.
- Resolve compliance issues.
- Optimize reimbursement processes.
- Perform other duties as assigned.
- Carry out responsibilities in alignment with Kettering Health's mission, vision, values, and B Safe program.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
