Payor Relations Contract Compliance Specialist - PFS

Job description

Job Details
PFS | Miamisburg | Full-time |First Shift
Responsibilities & Requirements
The Payor Relations Contract Compliance Specialist supports patient access and operational reliability by ensuring that payor contracts are accurately implemented, monitored, and maintained in compliance with regulatory and organizational standards. This role serves as a liaison between Kettering Health and external payors, analyzing contract terms, resolving compliance issues, and optimizing reimbursement processes. Performs other duties as assigned. All job responsibilities are to be carried out in alignment with Kettering Health's mission, vision, values, and B Safe program.
Required Education:
• High school diploma or equivalent.

Required Work Experience:
• Minimum of 3 years of experience in payor relations, managed care contracting, contract compliance, or a similar role within a healthcare setting.

Required Licenses, Certifications, and Registrations:
• None required.

Skills:
• Strong analytical and critical thinking skills
• proficiency in interpreting and analyzing contract language and reimbursement data
• effective verbal and written communication skills
• ability to collaborate with internal and external stakeholders
• working knowledge of healthcare regulations (e.g., HIPAA)
• proficiency with Microsoft Office Suite and contract management systems
• attention to detail
• ability to prioritize and manage multiple projects.

Preferred Qualifications
Preferred Education:
• Associate's degree in Healthcare Administration, Business, or related field, or equivalent combination of education and experience.

Preferred Work Experience:
• 5 or more years of experience in healthcare payor contracting, contract analysis, or revenue cycle management.

Preferred Licenses, Certifications, and Registrations:
• Certification in healthcare compliance (e.g., CHC, AAHAM, or HFMA) preferred.

Overview
Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God’s love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.