Identify and address lost revenue, underpayments, duplicate charges, billing errors, write-offs, and other financial leakage.
Maintain controls supporting accurate medication pricing, coding, documentation, billing, and reimbursement.
Partner with Pharmacy Informatics and Information Solutions to maintain medication billing configurations, charge codes, units of measure, and system logic.
Requirements
Bachelor's degree in Pharmacy, Finance, Accounting, Business Administration, Healthcare Administration, Health Information Management, or a related field
Investigate complex hospital and health plan claims to understand how accounts move through billing, submission, adjudication, payment, denial, and appeal. Identify reimbursement and pricing discrepancies and develop investigative reports and appeal narratives.
Compensation
$74,000.00 - $135,000.00 Annual. This role is also anticipated to be eligible to participate in an annual bonus plan.
Responsibilities
Trace disputed hospital and health plan claims through coding, billing, submission, payer edits, adjudication, payment posting, denials, recoupments, and appeals to establish the claim history.
Investigate pricing and reimbursement discrepancies by comparing billed charges, payer contract terms, rate schedules, expected allowed amounts, and actual payments; identify incorrect rates, adjustments, and payment logic.
Interpret provider agreements, reimbursement policies, and inpatient and outpatient payment methods, including DRG/APR-DRG, APC, case rates, fee schedules, and contractual carve-outs.
Review UB-04/CMS-1450 and CMS-1500 claims, 837/835 transactions, explanations of benefits, remittance advices, account notes, and payment histories to reconcile claim-level evidence.
Research denial and adjustment reasons using CARC/RARC codes, payer policies, coding guidance, denial letters, medical records, and prior appeal correspondence.
Investigate complex hospital and health plan claims to understand how an account moves through billing, claim submission, adjudication, payment, denial, and appeal. Identify reimbursement and pricing discrepancies, research reasons for claim denials, and develop clear investigative reports and appeal narratives.
Compensation
A reasonable estimate of the current range is $74,000.00 - $135,000.00 Annual.
Responsibilities
Trace disputed hospital and health plan claims through coding, billing, submission, payer edits, adjudication, payment posting, denials, recoupments, and appeals to establish the claim history.
Investigate pricing and reimbursement discrepancies by comparing billed charges, payer contract terms, rate schedules, expected allowed amounts, and actual payments.
Interpret provider agreements, reimbursement policies, and inpatient and outpatient payment methods, including DRG/APR-DRG, APC, case rates, fee schedules, and contractual carve-outs.
Review UB-04/CMS-1450 and CMS-1500 claims, 837/835 transactions, explanations of benefits, remittance advices, account notes, and payment histories to reconcile claim-level evidence.
Research denial and adjustment reasons using CARC/RARC codes, payer policies, coding guidance, denial letters, medical records, and prior appeal correspondence.
This remote position partners with the client’s leadership team to support commercial and Medicaid payer contracting, credentialing, reimbursement analysis, and focused billing compliance reviews.
Compensation
$50 per hour as a part-time W-2 employee.
Responsibilities
Prepare and submit commercial and Medicaid organizational applications, coordinate managed care organization enrollment and revalidation, and track contracting milestones, renewals, and outstanding requirements.
Review payer contracts and fee schedules, identify reimbursement variances, and flag provisions that may create operational or financial risk.
Manage organizational Type 2 NPI enrollments and service location additions, verify taxonomy alignment with licensed levels of care, and coordinate applicable CAQH profile updates.
Conduct focused reviews of behavioral health CPT and HCPCS billing practices against payer policies, covered services, and fee schedule requirements.
Evaluate authorization and documentation requirements, analyze denial patterns, and recommend corrective actions to leadership.
The Payer Relations Specialist serves as Espire Dental's primary liaison with dental insurance carriers and third-party payers. This role is responsible for developing and maintaining productive payer relationships, supporting contract negotiations and evaluations, monitoring reimbursement trends, resolving escalated payer issues, and advocating for fair and competitive reimbursement across the organization.
Responsibilities
Serve as the primary day-to-day contact for assigned dental insurance carriers, third-party administrators, and payer representatives.
Build productive relationships with payer contacts to improve communication, accountability, and issue resolution.
Maintain current payer contact information, escalation pathways, meeting notes, commitments, and follow-up items.
Represent Espire professionally in payer meetings, business reviews, and issue-resolution discussions.
Support the review of payer agreements, amendments, participation requirements, reimbursement terms, and fee schedules.
Requirements
Bachelor's degree in business, healthcare administration, or a related field
Support financial and operational performance across a growing portfolio of ambulatory surgery centers by analyzing revenue cycle data, identifying opportunities, and providing actionable insights.
Compensation
Salary ranges at Compass are based on role, level, and location, and may vary by state. Individual pay is determined by work location and factors such as relevant skills, experience, and education or training. Actual compensation will vary based on experience, qualifications, and company and individual performance.
Responsibilities
Develop and maintain accurate reporting on revenue cycle performance
Identify performance gaps and emerging risks
Analyze denial patterns, payment variances, and collection trends
Monitor key revenue cycle metrics
Analyze payer contracts and reimbursement rates
Requirements
Bachelor's degree in Finance, Accounting, Healthcare Administration, Business Analytics, Economics, Information Systems, or a related field
Nice to have: Experience supporting ambulatory surgery centers
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