Healthcare Payment Compliance and Contract Management Analyst - REMOTE
Remote · United States
Job Summary
Healthcare Payment Compliance and Contract Management (PCCM) Analyst is responsible for maximizing reimbursement by identifying variances between posted and expected revenue for managed care, government contracts, and other payers. This role analyzes contract compliance, identifies revenue opportunities, and communicates discrepancies to relevant departments. The PCCM Analyst collaborates with financial and clinical teams to improve revenue cycle processes and optimize payer relationships. Essential functions include analyzing contract reimbursement, managing underpayment appeals and follow-up, interpreting contract terms, compiling and presenting data on payment trends, reviewing payer policies, developing reports on payment discrepancies and performance metrics, and maintaining knowledge of medical coding systems to support accurate adjudication. Requires H.S. Diploma or GED, 2-4 years of experience in relevant areas, and strong data analysis, communication, and Excel skills.
Required Qualifications
- H.S. Diploma or GED required
- Associate Degree or higher preferred
- 2-4 years of experience in revenue cycle management, contract compliance, or healthcare reimbursement analysis required
- Strong understanding of managed care, government contracts, and reimbursement processes
- Proficiency in data analysis, with the ability to compile and interpret complex data sets related to contract compliance and payment trends
- Excellent communication and interpersonal skills for working with internal teams and external payer representatives
- Knowledge of medical coding systems (ICD-10, CPT, HCPCS, DRG, etc.) and how they affect claim adjudication
- Strong organizational skills, with the ability to manage multiple projects and deadlines
- Proficient in Google and Microsoft Office Suite, with intermediate to advanced Excel skills
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