Payer Contract Specialist
Santiam Hospital & Clinics, Sublimity, OR, United States
Payer Contract Specialist
Hybrid Sublimity, OR 97385 Overview
Salary Range $25.00 - $35.64 Hourly Job Shift Day Education Level High School Description
Who You'll Join: At Santiam Hospital & Clinics, we believe exceptional patient care starts with a supportive and inclusive work environment. We empower every team member by providing access to advanced medical technology and continuous professional development. Join our collaborative culture, where your contributions are valued and your growth is encouraged. As a Payor Contract Specialist, you will be responsible for translating healthcare payor contracts and fee schedules into precise Epic Resolute configurations. By maintaining a comprehensive contract matrix and collaborating with IT and third-party vendors, you will ensure accurate reimbursement modeling, optimize charge capture, and uphold the integrity of hospital price transparency estimates through rigorous testing and system validation. This opportunity is ideal for a professional with a sharp eye for detail, a strong background in hospital reimbursement and payor contracts. Take the next step in your healthcare careerapply today and bring your expertise to Santiam Hospital & Clinics, recently honored as 2025's Best Hospital in the Willamette Valley! Position Schedule: Monday - Friday, 8:00 am - 5:00 pm with some flexibility. What You'll Do: Review healthcare payor agreement, amendments, fee schedules, and reimbursement policies, and translate applicable legal or financial language from such documents into language that meets Epic configuration requirements. In effort to support effective operation and surveillance of payor reimbursement process, build and maintain a comprehensive organizational chart ("matrix") that outlines key payor contract components (e.g. reimbursement methodologies, rate structures, requirements related to payment for or provision of specialized healthcare materials or services considered to be beyond standard coverage ["carve outs"], payment timelines, required steps to challenge or appeal low reimbursement amounts or high denial rates ["escalation procedure;], and requirements for Hospital policy). Enter and maintain information about payor Master Files, contract terms (i.e. via "contract tables"), fee schedules, grouper or pricer logic particulars, and coverage limits ("coverage-level rules") into Epic revenue cycle software ("Epic Resolute") payor contract sub-module ("Contracts") and collaborate with third-party vendor to ensure that such information is accurately reflected in published Hospital price transparency estimates. Configure Epic Resolute Contracts to produce accurate expected reimbursement and price estimates, and ensure that Resolute workflows related to contract dating, versioning, or activation remain maximally effective. Work with Information Technology Department staff to ensure that verbiage used within Epic clinical environment is optimized for proper charge capture and that features of Epic Resolute or related software are appropriately implemented and best utilized. Develop revenue cycle test matrices and apply representative claims as use cases within such matrices to validate pricing, estimate expected reimbursement and discounts, and illustrate exception handling process through use of Epic financial discrepancy surveillance tools (i.e. "variance work queues"). Perform ongoing review of payor variance from expected reimbursement, underpayment, overpayment, denial trends, and late payment penalties, and compare such metrics with analogous payor contract terms. Recommend and implement reimbursement process improvement in effort to prevent avoidable denials, minimize non-automated processes, and increase first-pass yield. Perform ongoing evaluation of contract configuration and payor compliance with contract terms; identify indicated adjustment to contract terms, rates, carve-outs, or methodologies; and prioritize implementation of such adjustment based on potential financial impact, operational urgency, compliance concerns, and needs for alignment of such elements with Hospital strategies. Structure, automate, and support new or renewed payor contract modeling through provision and use of data-driven insights to negotiate such contracts and strategically guide pricing decisions that maximize revenue and efficiency. Record and maintain clear documentation about Epic Resolute configuration and configuration changes, decision logs, and contract source files. Help to ensure that reimbursement process under Hospital control remains compliant with payor requirements, Hospital policy, and state or federal law or regulations (e.g. Center for Medicare and Medicaid Services requirements). Develop quick reference guides within own expertise areas and share professional knowledge with Hospital staff who provide billing, follow-up, or customer services. Maintain current knowledge about Epic software updates, payor methodology changes, and healthcare market trends. Establish and maintain constructive and collaborative relationships with payor representatives that will facilitate productive contract discussions, expedite prompt issue resolution, and strengthen communication channels that will help to optimize related reimbursement process and efficiency. Perform other duties assigned by Chief executive Officer, Chief Operation Operator, or Revenue and Reimbursement Executive Director. Qualifications
What You'll Need: Knowledge of principles that relate to healthcare reimbursement systems and payor contracts. Superior aptitude in verbal and written communication. Possession of a high school diploma or proof of analogous education. Proficiency in analysis of large data sets through use of Hospital spreadsheet software (presently Microsoft Excel). At least three years of experience in payor contract analysis, hospital billing, professional billing, revenue integrity maintenance, or another healthcare revenue cycle role. At least two years of experience in use of Hospital electronic medical records (presently Epic). Possession, within six months after hire, of Epic Resolute Hospital Billing and Professional Billing certifications. Demonstrated skill in analysis and documentation, as well as exacting and meticulous attention to detail. Possession of United States proof of citizenship or right to work in the United States. Possession of a driver license or analogous identification. Willingness to participate in Hospital orientation and educational in-service. Benefits for Eligible Positions: Medical, Vision and Dental Insurance PTO and holiday pay Employee Referral Program 401(k) Retirement Life Insurance Long Term Disability Employee Discounts Bilingual Pay Differential for eligible positions Public Service Loan Forgiveness for eligible positions Tuition Assistance for eligible positions Why Santiam Hospital? At Santiam Hospital & Clinics, we pride ourselves on fostering a supportive and inclusive work environment where every team member is valued and empowered to make a difference. Our commitment to excellence in patient care is matched by our dedication to employee growth and well-being. As part of our team, you'll have access to cutting-edge medical technology, ongoing professional development opportunities, and a collaborative culture that encourages innovation and teamwork. Join us at Santiam Hospital & Clinics, where your skills and compassion will be appreciated, and together, we can make a positive impact on the health and lives of our community. With 13 clinics offering 8 specialties, you'll be part of a diverse and dynamic healthcare community. We're proud to have been named the 2025 Best Place to Have a Baby, Best Hospital as well as receiving accolades for our Surgery Center, Medical Facility and Women's Clinic, reflecting our unwavering commitment to providing exceptional care for our patients. Santiam Hospital & Clinics is a drug-free workplace in accordance with the Drug-Free Workplace Act of 1988 and an EEO Affirmative Action Race/Sex/Sexual Orientation/Gender Identity/National Origin/Veteran/Disability Employer.
Hybrid Sublimity, OR 97385 Overview
Salary Range $25.00 - $35.64 Hourly Job Shift Day Education Level High School Description
Who You'll Join: At Santiam Hospital & Clinics, we believe exceptional patient care starts with a supportive and inclusive work environment. We empower every team member by providing access to advanced medical technology and continuous professional development. Join our collaborative culture, where your contributions are valued and your growth is encouraged. As a Payor Contract Specialist, you will be responsible for translating healthcare payor contracts and fee schedules into precise Epic Resolute configurations. By maintaining a comprehensive contract matrix and collaborating with IT and third-party vendors, you will ensure accurate reimbursement modeling, optimize charge capture, and uphold the integrity of hospital price transparency estimates through rigorous testing and system validation. This opportunity is ideal for a professional with a sharp eye for detail, a strong background in hospital reimbursement and payor contracts. Take the next step in your healthcare careerapply today and bring your expertise to Santiam Hospital & Clinics, recently honored as 2025's Best Hospital in the Willamette Valley! Position Schedule: Monday - Friday, 8:00 am - 5:00 pm with some flexibility. What You'll Do: Review healthcare payor agreement, amendments, fee schedules, and reimbursement policies, and translate applicable legal or financial language from such documents into language that meets Epic configuration requirements. In effort to support effective operation and surveillance of payor reimbursement process, build and maintain a comprehensive organizational chart ("matrix") that outlines key payor contract components (e.g. reimbursement methodologies, rate structures, requirements related to payment for or provision of specialized healthcare materials or services considered to be beyond standard coverage ["carve outs"], payment timelines, required steps to challenge or appeal low reimbursement amounts or high denial rates ["escalation procedure;], and requirements for Hospital policy). Enter and maintain information about payor Master Files, contract terms (i.e. via "contract tables"), fee schedules, grouper or pricer logic particulars, and coverage limits ("coverage-level rules") into Epic revenue cycle software ("Epic Resolute") payor contract sub-module ("Contracts") and collaborate with third-party vendor to ensure that such information is accurately reflected in published Hospital price transparency estimates. Configure Epic Resolute Contracts to produce accurate expected reimbursement and price estimates, and ensure that Resolute workflows related to contract dating, versioning, or activation remain maximally effective. Work with Information Technology Department staff to ensure that verbiage used within Epic clinical environment is optimized for proper charge capture and that features of Epic Resolute or related software are appropriately implemented and best utilized. Develop revenue cycle test matrices and apply representative claims as use cases within such matrices to validate pricing, estimate expected reimbursement and discounts, and illustrate exception handling process through use of Epic financial discrepancy surveillance tools (i.e. "variance work queues"). Perform ongoing review of payor variance from expected reimbursement, underpayment, overpayment, denial trends, and late payment penalties, and compare such metrics with analogous payor contract terms. Recommend and implement reimbursement process improvement in effort to prevent avoidable denials, minimize non-automated processes, and increase first-pass yield. Perform ongoing evaluation of contract configuration and payor compliance with contract terms; identify indicated adjustment to contract terms, rates, carve-outs, or methodologies; and prioritize implementation of such adjustment based on potential financial impact, operational urgency, compliance concerns, and needs for alignment of such elements with Hospital strategies. Structure, automate, and support new or renewed payor contract modeling through provision and use of data-driven insights to negotiate such contracts and strategically guide pricing decisions that maximize revenue and efficiency. Record and maintain clear documentation about Epic Resolute configuration and configuration changes, decision logs, and contract source files. Help to ensure that reimbursement process under Hospital control remains compliant with payor requirements, Hospital policy, and state or federal law or regulations (e.g. Center for Medicare and Medicaid Services requirements). Develop quick reference guides within own expertise areas and share professional knowledge with Hospital staff who provide billing, follow-up, or customer services. Maintain current knowledge about Epic software updates, payor methodology changes, and healthcare market trends. Establish and maintain constructive and collaborative relationships with payor representatives that will facilitate productive contract discussions, expedite prompt issue resolution, and strengthen communication channels that will help to optimize related reimbursement process and efficiency. Perform other duties assigned by Chief executive Officer, Chief Operation Operator, or Revenue and Reimbursement Executive Director. Qualifications
What You'll Need: Knowledge of principles that relate to healthcare reimbursement systems and payor contracts. Superior aptitude in verbal and written communication. Possession of a high school diploma or proof of analogous education. Proficiency in analysis of large data sets through use of Hospital spreadsheet software (presently Microsoft Excel). At least three years of experience in payor contract analysis, hospital billing, professional billing, revenue integrity maintenance, or another healthcare revenue cycle role. At least two years of experience in use of Hospital electronic medical records (presently Epic). Possession, within six months after hire, of Epic Resolute Hospital Billing and Professional Billing certifications. Demonstrated skill in analysis and documentation, as well as exacting and meticulous attention to detail. Possession of United States proof of citizenship or right to work in the United States. Possession of a driver license or analogous identification. Willingness to participate in Hospital orientation and educational in-service. Benefits for Eligible Positions: Medical, Vision and Dental Insurance PTO and holiday pay Employee Referral Program 401(k) Retirement Life Insurance Long Term Disability Employee Discounts Bilingual Pay Differential for eligible positions Public Service Loan Forgiveness for eligible positions Tuition Assistance for eligible positions Why Santiam Hospital? At Santiam Hospital & Clinics, we pride ourselves on fostering a supportive and inclusive work environment where every team member is valued and empowered to make a difference. Our commitment to excellence in patient care is matched by our dedication to employee growth and well-being. As part of our team, you'll have access to cutting-edge medical technology, ongoing professional development opportunities, and a collaborative culture that encourages innovation and teamwork. Join us at Santiam Hospital & Clinics, where your skills and compassion will be appreciated, and together, we can make a positive impact on the health and lives of our community. With 13 clinics offering 8 specialties, you'll be part of a diverse and dynamic healthcare community. We're proud to have been named the 2025 Best Place to Have a Baby, Best Hospital as well as receiving accolades for our Surgery Center, Medical Facility and Women's Clinic, reflecting our unwavering commitment to providing exceptional care for our patients. Santiam Hospital & Clinics is a drug-free workplace in accordance with the Drug-Free Workplace Act of 1988 and an EEO Affirmative Action Race/Sex/Sexual Orientation/Gender Identity/National Origin/Veteran/Disability Employer.