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Payor Contract Specialist

Remote

Payor Contract Specialist: 🤝📄

The Payor Contract Specialist supports the Contracting Manager by executing and maintaining accurate provider and contract data across payor systems and directories. This role is highly task-oriented and detail-driven, with a primary focus on ensuring provider and group information is accurate, compliant, and consistently represented across payor network directories and internal systems.

This job is “HOT”: 🔥

This position plays a critical role in protecting data integrity, supporting delegated credentialing requirements, and assisting with contract maintenance activities such as audits, amendments, and reporting.

Business impact: 📈

Provider Directory & Data Management

  • Maintain accurate provider and medical group data across payor network directories and internal systems
  • Collect, validate, and update provider demographic, credentialing, and practice information to ensure directory accuracy
  • Monitor payor directory listings to confirm providers are displayed correctly and in compliance with contractual and regulatory requirements
  • Support ongoing provider data clean-up efforts and remediation as needed

Contract Data & Research Support

  • Assist with researching payor lines of business, fee schedules, and contractual requirements
  • Review and analyze contract amendments and updates for data and operational impact
  • Support contract organization, clean-up efforts, and documentation for audits or internal reviews
  • Track and maintain contract-related data to support reporting and compliance needs

Delegated Credentialing & Reporting Support

  • Assist with monthly delegated credentialing audits and required reporting
  • Support data validation efforts to ensure delegated credentialing standards are met
  • Help prepare and maintain documentation needed for payor reviews and compliance checks
  • Assist with researching and applying for new delegated credentialing opportunities

Issue Resolution & Operational Support

  • Investigate and resolve contract discrepancies that impact directories, enrollment, or claims
  • Track and document recurring data or directory issues to support continuous improvement
  • Respond to and support internal requests related to contract information and status
  • Communicate contractual statuses with payors to the company in an organized way

Cross-Functional Collaboration

  • Work closely with contracting, credentialing, enrollment, billing, and operations teams to ensure data consistency
  • Support the Contracting Manager with day-to-day operational tasks and follow-ups related to payor data and contracts

What you will need to succeed: 🌱

Education

  • Associate’s or Bachelor’s degree preferred. 
  • 2–4 years of related experience, in lieu of a bachelor’s degree, in provider data management, credentialing, enrollment, or healthcare operations

 

Experience

  • 2–4 years in provider data or credentialing.
  • Independently manage provider data lifecycle
  • Data entry, verification, and support tasks
  • Exposure to claims, billing, or contracting workflows and how provider data impacts them

 

Skills

  • Knowledge of healthcare provider data, credentialing, and enrollment processes. 
  • Familiarity with healthcare regulations (CMS, NCQA, HIPAA). Strong attention to detail and data accuracy. 
  • Proficiency in provider data systems, databases, and Google docs/sheets.
  • Ability to manage multiple deadlines and priorities. 
  • Effective communication and problem-solving skills.

 

Attributes 

  • Detail-oriented with strong organizational skills. 
  • Ability to work independently and as part of a team. 
  • Problem-solving mindset with the ability to troubleshoot enrollment issues and propose actionable solutions.
  • Ability to meet strict deadlines and manage high-volume, time-sensitive workloads.
  • Commitment to maintaining clean, accurate, audit-ready documentation.
  • Demonstrated ability to handle sensitive information with confidentiality.

 

What we offer: 💼 ✨

  • The compensation range for this role is $60,000-70,000 annually.
  • Desirable benefits package, including:
    • Health, dental and vision
    • Paid holidays
    • Flexible time off

 

The interview process will include: 📚

  1. Recruiter Screen (30 min)

  2. Hiring Manager Screen (45 min)

  3. Final Interview (30 min)

**Application window closes 5:00 PM EDT Friday February 20th**

This role is not eligible for sponsorship. Must have authorization to work in the United States now and in the future.

#LI-DS1

 

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