Payor Contract Specialist

Job Description

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
  • Flexible time off

The interview process will include: 📚

1. Recruiter Screen (30 min)

2. Hiring Manager Screen (45 min)

3. Final Interview (30 min)

**Application window closes 5:00 PM EDT Friday February 20th**

This role is not eligible for sponsorship. Must have authorization to work in the United States now and in the future.

#LI-DS1

Please note that all official communication from Midi Health will come from an @joinmidi.com email address. We will never ask for payment of any kind during the application or hiring process. If you receive any suspicious communication claiming to be from Midi Health, please report it immediately by emailing us at [email protected].

Midi Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Please find our CCPA Privacy Notice for California Candidates here.