Payer Operations Specialist
Distro
full-time
Posted on:
Location Type: Remote
Location: Colombia
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Salary
💰 $10 - $15 per hour
About the role
- The Payer Operations Analyst plays a critical role in ensuring the accuracy, efficiency, and integrity of payer-related setup and operations across Thriveworks systems.
- Responsible for translating payer contracts into precise system configurations, managing fee schedules, maintaining high-quality payer data, and supporting operational readiness across Revenue Cycle, Credentialing, and EHR functions.
- Implement and maintain payer configuration details across the EHR and related systems.
- Support the loading, updating, and auditing of payer fee schedules based on executed contracts.
- Partner with the EHR administration team to configure and test payer setups.
- Conduct ongoing QA audits to validate payer configuration accuracy and maintain system data quality.
- Collaborate closely with a third‑party billing vendor to resolve claim routing issues.
- Monitor payer portals for updates to policies, fee schedules, and billing guidelines.
- Identify opportunities to automate payer setup processes and improve data hygiene.
Requirements
- Bachelor’s degree in Healthcare Administration, Business, or related field; or equivalent experience.
- 3–5 years of experience in healthcare payer operations, provider network setup, EHR configuration, or related areas within a provider organization.
- Strong understanding of payer configuration elements: payer IDs, EDI enrollments, claims addresses, plan IDs, reimbursement structures, and fee schedule loading.
- Experience collaborating with third‑party billing vendors or RCM teams.
- Proficiency with payer portals such as Availity, NaviNet, and Change Healthcare.
- Demonstrated attention to detail with proven success in maintaining data integrity and QA processes.
- Strong organizational, communication, and project management skills.
- Experience in behavioral health or outpatient healthcare settings.
- Familiarity with AdvancedMD or similar EHR/Practice Management systems.
- Knowledge of payer policies, reimbursement methodologies, and provider enrollment workflows.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
payer configurationfee schedule loadingEHR configurationQA auditingdata integrityclaims processingreimbursement structuresEDI enrollmentsprovider enrollment workflowsdata hygiene
Soft Skills
attention to detailorganizational skillscommunication skillsproject management skills
Certifications
Bachelor’s degree in Healthcare AdministrationBachelor’s degree in Business