Sr. Payor Relations Specialist Position Available In Charleston, South Carolina

Sr. Payor Relations Specialist
Full Time
Charleston, SC, Charleston, SC, US
+1 More Locations
6 days ago

Requisition ID:

2287

Salary Range:

$19.50 To $25.50 Hourly At XiFin, a culture of inclusivity is in our very fabric. We believe that this culture not only creates a more equitable and functional workplace, but also enhances our team members’ work experiences by promoting creativity, innovation, and collaboration. Who are we looking for? experienced and proactive Senior Payor Relations Specialist to join our team. In this pivotal role, you will be responsible for building and maintaining strong relationships with health plans and providers, ensuring seamless communication, and driving operational efficiency in payer relations. This is a dynamic, high-impact position that requires advanced knowledge of payer policies, medical claims processes, and pharmacy billing practices. You will play an integral role in identifying payer-specific requirements, researching medical policies, coordinating product rollouts, and ensuring accurate updates to pricing and billing information. You may be hired as a Specialist or Sr. Specialist based on your depth of skill and breadth of experience. What will you do?

Strategic Relationship Building:

Cultivate and maintain strong relationships with key stakeholders in health plans and provider networks, ensuring ongoing collaboration and effective communication.

Payer Setup & Pharmacy Claims Management:

Oversee and identify payer-specific setup requirements for pharmacy claim submissions. Ensure compliance and accuracy in submissions, proactively addressing payer-specific guidelines and policies.

Policy Research & Compliance:

Lead efforts to research and stay informed about medical policies across various payers. Analyze changes and updates to policies, ensuring compliance with evolving standards.

Billing Requirements & Fee Schedules:

Continuously monitor and maintain up-to-date payer billing requirements, including changes to pricing, fee schedules, and payment structures. Ensure alignment with internal systems and external payer expectations.

Product Coordination & Integration:

Collaborate with internal teams to facilitate the smooth rollout and integration of new products, ensuring they align with payer policies and billing guidelines.

Pricing & Fee Schedule Monitoring:

Stay ahead of pricing and fee schedule changes, working with internal teams to ensure timely updates and alignments with payer policies.
Collaboration with Level 2

Support:

Work closely with the Level 2 support team to ensure efficient and accurate updates to payer and provider information, driving operational excellence.

Documentation & Reporting:

Maintain thorough and accurate records of payer interactions, policy updates, product coordination efforts, and billing requirements. Ensure that all relevant documentation is up-to-date and accessible for team use. This is an onsite position at our office in Dallas, TX or Charleston, SC. What education and experience do you need? A combination of the following education and experience factors will be considered: High school diploma or equivalent required.
A Bachelor’s degree in Business Administration, Healthcare Management, or a related field is preferred; additional certifications or specialized training in healthcare, payer relations, or pharmacy claims is a plus.
5+ years of experience in payer relations, provider coordination, healthcare billing, or medical claims management, with significant expertise in managing complex payer relationships.
Strong understanding of payer policies, medical claims processes, pharmacy claim submissions, and healthcare billing practices.
Expertise in researching and interpreting medical policies across multiple payers.
Demonstrated experience in utilizing healthcare management systems or payer-related software tools.
Advanced communication skills, with the ability to effectively collaborate with providers, health plans, and internal teams.
Exceptional attention to detail and a proven track record of ensuring accuracy and compliance in all tasks.
Ability to thrive both independently and as part of a team in a fast-paced, ever-evolving environment.
Knowledge of state, federal, and third-party regulations and standards in healthcare is preferred.
Provider relations experience highly desirable.

Qualifications:

Excellent verbal and written communication skills.
Team player attitude with the ability to collaborate effectively with others.
Knowledge of applicable state, federal, and third-party regulations and standards (preferred).
Provider relations experience (preferred).

Work Environment:

This position requires a detail-oriented, communicative, and proactive individual who thrives in a collaborative team environment. The Payor Relations Specialist must be able to manage multiple tasks efficiently while maintaining a high level of accuracy and compliance. What’s in it for me? We don’t just offer benefits; we offer a comprehensive and flexible benefits package tailored for you! Dive into a world of cutting-edge healthcare with our comprehensive medical, dental and vision benefits, including telehealth services. Say goodbye to the hassle of prescriptions with our convenient mail-order program for 90-day maintenance medications.
Our Health Savings Account (HSA) featuring pre-tax deductions and quarterly company contributions (HSA only) puts more money in your pockets!
Plan for your golden years with confidence through our 401k retirement plan, complete with a company match. Fuel your ambition with our Tuition Assistance program, empowering you to reach new heights in your professional journey.
Finally, experience true well-being with XiFin’s BeWell Program, where we champion physical, mental, financial, and social wellness, because your success and happiness are our ultimate priorities Why XiFin? XiFin is a healthcare information technology company that empowers healthcare organizations to navigate an increasingly complex and evolving healthcare landscape. Through innovative AI-enabled technologies and services, we deliver operational efficiency, interoperability, and simplicity. The company’s revenue cycle management, clinical workflow enablement, laboratory information system, and patient engagement solutions enable organizations to achieve stronger finances, streamline operations, and develop industry-leading business strategies. Helping healthcare providers achieve financial strength empowers them to do more good for more people. That’s

THE POWER TO DO GOOD.

What does the position pay: Compensation is determined by several factors which may include skillset, experience level, and geographic location. The expected range for this role is $19.50- $25.50 hourly compensation. Please note this range is an estimate and actual may vary based on qualifications and experience. If you are an individual with a disability and would like to request a reasonable accommodation as part of the application or recruiting process, please contact us at 858-436-2901. EEO Statement XiFin is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.