The specialist manages payor-initiated audits, oversees delegated credentialing, and ensures data integrity for provider enrollment and billing systems. They also develop policies, controls, and reporting to mitigate compliance and revenue risks across the organization.
The analyst is responsible for building, updating, and managing high-volume dental insurance fee schedules across multiple platforms and providers. They will also investigate fee discrepancies, resolve support tickets, and collaborate with cross-functional teams to ensure billing accuracy.
The Payor Pricing Analyst builds and maintains financial models to drive payor contract strategy and optimize fee schedules. They also prepare negotiation briefs and provide data-driven insights to support leadership in payor meetings and contract renewals.
