1+ months

Payer Compliance Specialist

Weill Medical College of Cornell University
New York, NY 10007
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Position Summary

Supports contract compliance operations and assists in monitoring non\-compliance with contract terms, validation of physician and fee schedules setup\. Works with managed care organization to resolve contract related issues\.

Job Responsibilities

+ Monitors and analyzes data to identify routine contract related issues, improper contracted fee schedule linkage and other physician setup issues during new contract, amendment and new fee schedule implementations\.

+ Assists with maintaining queries and reports from various databases, applications and data provided by managed care organizations that are necessary to managed contracts\. Escalates data discrepancies\.

+ Coordinates and prepares routine monthly and ad hoc reports on managed care contract compliance and recovery activities\.

+ Serves as a liaison with managed care organization representatives to facilitate the explanation or resolution of routine contracting and claim issues for the Physician Organization and voluntary faculty who are in the IPA\.

+ Researches payment errors and performs follow up activities\. Investigates and resolves problematic claim accounts\.

+ Remains up to date with managed care carrier updates regarding claim submissions, claim appeals, grievance procedures, payment and medical policies by reviewing payer newsletters, alerts or attending webinars\.

+ Verifies accuracy and completeness of relevant information in the Contract Management system; researches inconsistencies against contract exhibits and prepares documentation that supports change requests\.


+ Associate's Degree in related field


Bachelor's degree preferred\.

Approximately 3 years of physician billing, accounts receivable and/or collection experience\.

Must have thorough understanding of third party healthcare reimbursement regulations, and CPT coding\.

Experience working in an academic environment is highly desired\.

BA/BS in Business Administration, Accounting, Finance, Economics or related field is highly desired\.

Knowledge, Skills and Abilities

+ Ability to multi\-task and self\-prioritize work\.

+ Demonstrated strong communication and interpersonal skills; demonstrated ability to interact with multiple constituencies and exercise "people skills"\.

+ Advanced problem solving and analytical skills\.

Licenses and Certifications

Working Conditions/Physical Demands

Weill Cornell Medicine is a comprehensive academic medical center that's committed to excellence in patient care, scientific discovery, and the education of future physicians in New York City and around the world\. Our doctors and scientists\-faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and the Weill Cornell Physician Organization\-are engaged in world\-class clinical care and cutting\-edge research that connect patients to the latest treatment innovations and prevention strategies\. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where an international campus offers a U\.S\. medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey\. Our medical practices serve communities throughout New York City, and our faculty provide comprehensive care at NewYork\-Presbyterian Hospital/Weill Cornell Medical Center, NewYork\-Presbyterian/Lower Manhattan Hospital, and NewYork\-Presbyterian/Queens\. At Weill Cornell Medicine, we work together to treat each individual, not just their conditions or illnesses, as we strive to deliver the finest possible care for our patients \- the center of everything we do\. Weill Cornell Medicine is an Equal Employment Opportunity Employer\. Weill Cornell Medicine provides equal employment opportunities to all qualified applicants without regard to race, sex, sexual orientation, gender identity, national origin, color, age, religion, protected veteran or disability status, or genetic information\.
Posted: 2019-09-25 Expires: 2019-11-28

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Payer Compliance Specialist

Weill Medical College of Cornell University
New York, NY 10007

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