CHS Shared Business Operations, LLC
Payment Compliance & Contract Management Specialist (REMOTE)
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Full Time
Job Summary
The Payment Compliance & Contract Management (PCCM) Specialist (Remote) serves as a subject matter expert and team lead, responsible for maximizing reimbursement through the identification of revenue opportunities and resolution of contractual variances. This role oversees quality assurance and performance management processes, providing guidance to team members and allocating workloads effectively. This role also involves analyzing reimbursement discrepancies, providing strategic insights, and collaborating with internal and external stakeholders to improve revenue cycle processes.
Essential Functions
The Payment Compliance and Contract Management (PCCM) team plays a critical role in ensuring that payments are made according to contractual agreements and regulatory requirements. The team oversees the full contract lifecycle, focusing on analyzing reimbursement discrepancies, improving revenue cycle processes, and ensuring compliance with contract terms to support financial accuracy and operational efficiency.
Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
The Payment Compliance & Contract Management (PCCM) Specialist (Remote) serves as a subject matter expert and team lead, responsible for maximizing reimbursement through the identification of revenue opportunities and resolution of contractual variances. This role oversees quality assurance and performance management processes, providing guidance to team members and allocating workloads effectively. This role also involves analyzing reimbursement discrepancies, providing strategic insights, and collaborating with internal and external stakeholders to improve revenue cycle processes.
Essential Functions
- Conducts quality monitoring to ensure team performance meets departmental metrics, and provides actionable recommendations to senior leadership when KPIs are not achieved.
- Trains and mentors staff to ensure team efficiency and compliance with departmental standards.
- Manages, maintains, and directs key technologies administered by the department to support payment compliance and contract management activities.
- Analyzes workload demands through data analysis, assigning tasks to team members based on priorities and department needs.
- Identifies opportunities for process improvement and collaborates with external organizations to enhance payment integrity and optimize contract modeling.
- Performs other duties as assigned.
- Complies with all policies and standards.
- Bachelor's Degree or equivalent work experience on a year-for-year basis required
- 3-5 years of experience in healthcare reimbursement, contract management, or revenue cycle operations required
- Demonstrated expertise in analyzing and interpreting payer contracts and reimbursement methodologies required
- Strong analytical and data interpretation skills.
- Advanced understanding of healthcare reimbursement systems and payer contracts.
- Excellent leadership and team collaboration abilities.
- Effective communication and presentation skills.
- Proficiency in data analysis tools and healthcare billing software.
- High attention to detail and ability to manage multiple priorities.
The Payment Compliance and Contract Management (PCCM) team plays a critical role in ensuring that payments are made according to contractual agreements and regulatory requirements. The team oversees the full contract lifecycle, focusing on analyzing reimbursement discrepancies, improving revenue cycle processes, and ensuring compliance with contract terms to support financial accuracy and operational efficiency.
Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.