About the Role
The Payer Compliance Specialist ensures all payer requirements are met by maintaining accurate records, verifying insurance policies, and supporting compliance processes across billing and patient services.
Responsibilities
- Verify insurance policies for accuracy and completeness
- Ensure compliance with payer-specific documentation standards
- Review patient records to confirm adherence to billing requirements
- Collaborate with billing teams to resolve compliance discrepancies
- Monitor changes in payer policies and update internal procedures
- Support audits by providing accurate and timely documentation
- Identify gaps in compliance and recommend corrective actions
- Maintain up-to-date knowledge of insurance regulations
- Assist in training staff on compliance protocols
- Track compliance metrics and report findings
- Communicate with external payers to clarify requirements
- Process authorization requests in line with payer rules
- Ensure timely submission of required documentation
- Escalate complex compliance issues to management
- Maintain confidentiality of patient and payer data
- Support internal compliance reviews
- Coordinate with patient services to verify coverage details
- Validate enrollment status with insurance providers
- Update compliance databases with current information
- Respond to compliance-related inquiries from internal teams
Nice to Have
- Certification in medical compliance or billing
- Experience with Medicaid or Medicare compliance
- Familiarity with telehealth platforms
- Prior work in speech or behavioral therapy services
- Knowledge of ICD-10 and CPT coding
- Experience using practice management software
- Background in regulatory compliance audits
Compensation
Not specified
Work Arrangement
Remote (Worldwide)
Team
Not specified
Why This Role Matters
This position plays a key role in maintaining the integrity of billing operations by ensuring all payer rules are followed, reducing denials and improving revenue cycle efficiency.
What We Value
We prioritize accuracy, proactive problem-solving, and clear communication across teams to uphold compliance standards in a fast-evolving healthcare environment.
Not specified
