Job Details

Job Summary

The Payment Compliance & Contract Management (PCCM) Specialist (Remote) serves as a subject matter expert and team lead, responsible for maximizing reimbursement through the identification of revenue opportunities and resolution of contractual variances. This role oversees quality assurance and performance management processes, providing guidance to team members and allocating workloads effectively. This role also involves analyzing reimbursement discrepancies, providing strategic insights, and collaborating with internal and external stakeholders to improve revenue cycle processes.

Essential Functions

• Conducts quality monitoring to ensure team performance meets departmental metrics, and provides actionable recommendations to senior leadership when KPIs are not achieved.

• Trains and mentors staff to ensure team efficiency and compliance with departmental standards.

• Manages, maintains, and directs key technologies administered by the department to support payment compliance and contract management activities.

• Analyzes workload demands through data analysis, assigning tasks to team members based on priorities and department needs.

• Identifies opportunities for process improvement and collaborates with external organizations to enhance payment integrity and optimize contract modeling.

• Performs other duties as assigned.

• Complies with all policies and standards.

Qualifications

• Bachelor's Degree or equivalent work experience on a year-for-year basis required

• 3-5 years of experience in healthcare reimbursement, contract management, or revenue cycle operations required

• Demonstrated expertise in analyzing and interpreting payer contracts and reimbursement methodologies required

Knowledge, Skills and Abilities

• Strong analytical and data interpretation skills.

• Advanced understanding of healthcare reimbursement systems and payer contracts.

• Excellent leadership and team collaboration abilities.

• Effective communication and presentation skills.

• Proficiency in data analysis tools and healthcare billing software.

• High attention to detail and ability to manage multiple priorities.

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to to obtain the main telephone number of the facility and ask for Human Resources.