Payor Contract Specialist: 🤝📄

The Payor Contract Specialist supports the Contracting Manager by executing and maintaining accurate provider and contract data across payor systems and directories. This role is highly task-oriented and detail-driven, with a primary focus on ensuring provider and group information is accurate, compliant, and consistently represented across payor network directories and internal systems.

This job is “HOT”: 🔥

This position plays a critical role in protecting data integrity, supporting delegated credentialing requirements, and assisting with contract maintenance activities such as audits, amendments, and reporting.

Business impact: 📈

Provider Directory & Data Management

• Maintain accurate provider and medical group data across payor network directories and internal systems
• Collect, validate, and update provider demographic, credentialing, and practice information to ensure directory accuracy
• Monitor payor directory listings to confirm providers are displayed correctly and in compliance with contractual and regulatory requirements
• Support ongoing provider data clean-up efforts and remediation as needed
  
  

Contract Data & Research Support

• Assist with researching payor lines of business, fee schedules, and contractual requirements
• Review and analyze contract amendments and updates for data and operational impact
• Support contract organization, clean-up efforts, and documentation for audits or internal reviews
• Track and maintain contract-related data to support reporting and compliance needs
  
  

Delegated Credentialing & Reporting Support

• Assist with monthly delegated credentialing audits and required reporting
• Support data validation efforts to ensure delegated credentialing standards are met
• Help prepare and maintain documentation needed for payor reviews and compliance checks
• Assist with researching and applying for new delegated credentialing opportunities
  
  

Issue Resolution & Operational Support

• Investigate and resolve contract discrepancies that impact directories, enrollment, or claims
• Track and document recurring data or directory issues to support continuous improvement
• Respond to and support internal requests related to contract information and status
• Communicate contractual statuses with payors to the company in an organized way
  
  

Cross-Functional Collaboration

• Work closely with contracting, credentialing, enrollment, billing, and operations teams to ensure data consistency
• Support the Contracting Manager with day-to-day operational tasks and follow-ups related to payor data and contracts

What you will need to succeed: 🌱

Education

• Associate’s or Bachelor’s degree preferred. 
• 2–4 years of related experience, in lieu of a bachelor’s degree, in provider data management, credentialing, enrollment, or healthcare operations

 

Experience

• 2–4 years in provider data or credentialing.
• Independently manage provider data lifecycle
• Data entry, verification, and support tasks
• Exposure to claims, billing, or contracting workflows and how provider data impacts them

 

Skills

• Knowledge of healthcare provider data, credentialing, and enrollment processes. 
• Familiarity with healthcare regulations (CMS, NCQA, HIPAA). Strong attention to detail and data accuracy. 
• Proficiency in provider data systems, databases, and Google docs/sheets.
• Ability to manage multiple deadlines and priorities. 
• Effective communication and problem-solving skills.

 

Attributes 

• Detail-oriented with strong organizational skills. 
• Ability to work independently and as part of a team. 
• Problem-solving mindset with the ability to troubleshoot enrollment issues and propose actionable solutions.
• Ability to meet strict deadlines and manage high-volume, time-sensitive workloads.
• Commitment to maintaining clean, accurate, audit-ready documentation.
• Demonstrated ability to handle sensitive information with confidentiality.

 

What we offer: 💼 ✨

• The compensation range for this role is $60,000-70,000 annually.
• Desirable benefits package, including:
• Health, dental and vision
• Paid holidays