Payer Contract Specialist
Job Type

The Payer Contract Specialist is responsible for understanding insurance contracts, reviewing underpayments, identifying trends in payment discrepancies amongst payers, and other assigned duties listed in requirements.



· Reviewing underpayments to determine if additional payment amounts can be requested

· Understanding insurance contract terms

· Ability to present ideas on complex, detailed issues with ease

· Mathematical skills: ability to calculate rates using addition, subtraction, multiplication and division

· Identifying trends in payment discrepancies amongst payers

· Auditing closed balance and write-off claims to ensure accuracy of payment to contract 

· Working with contract management to identify opportunities when negotiating contracts with payers  

· Understands payer determination, contract fees, covered or non-covered items, diagnosis, modifiers, valid HCPC, prescriptions, authorization, eligibility, etc.

· Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form

· Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook

· Experience working with ICD-9, CPT-4 and/or HCPCS coding systems

· Knowledge of insurance submittal procedures and medical forms (including UB04 and CMS1500)  

· Performs other duties, as assigned.