About the Role
The Insurance Data Management Specialist is integral to ensuring the efficient and compliant operation of revenue cycle platforms. This role involves the setup, maintenance, auditing, and optimization of payor-related system configurations. The specialist will ensure accurate implementation of payor contracts, reimbursement methodologies, billing rules, fee schedules, and claims processing requirements.

Responsibilities

• Configure and maintain payor plans, reimbursement methodologies, fee schedules, contractual allowances, and billing rules.
• Implement new payor contracts and update existing configurations based on contract amendments and reimbursement changes.
• Support Billing, Verification of Benefits (VOB), Prior Authorization, and Collections teams with insurance research and payer-related inquiries.
• Investigate claim status issues and assist in identifying payer-related root causes affecting reimbursement.
• Ensure configurations comply with contractual obligations, payer policies, and regulatory requirements.
• Develop and maintain payer reference materials, workflows, and process documentation.
  
  Education Qualification
• High school diploma or equivalent.
  
  Required Skills
• Minimum 2 years of experience in healthcare insurance, revenue cycle management, eligibility verification, billing, or insurance data management.
• Working knowledge of commercial, Medicare, Medicaid, and managed care insurance plans.
• Strong understanding of healthcare reimbursement and payor contract interpretation.
• Experience researching payer policies and insurance requirements.
• Strong analytical, organizational, and problem-solving skills.
• Excellent communication and collaboration skills.

The Company offers the following benefits for this position, subject to applicable eligibility requirements: medical insurance, dental insurance, vision insurance, 401(k) retirement plan, life insurance, long-term disability insurance, short-term disability insurance, paid parking/public transportation, paid time off, paid sick and safe time, hours of paid vacation time, weeks of paid parental leave, and paid holidays annually – as applicable.

Payrange:- $20/hr - $28/hr