Payer Profile Specialist

Statement of the Position:

 The Payer Profile Specialist is primarily responsible for maintaining the accuracy of the company’s Universal Payer Database, which tracks essential payer-specific information to support funding, billing, and collection departments. This role manages payer web portal access, supports management projects, and serves as a central point of contact for cross-functional teams to resolve database and access requests with speed and precision. This position reports directly to the Payer Relations Manager.

Company Description:

At all levels, working at National Seating & Mobility provides the opportunity to directly impact our client’s lives by giving them self-reliance and independence. Our teams are comprised of passionate individuals, dedicated to providing the best care to each client. We focus on abilities by leveraging technology and creating mobility solutions that are as unique as our client’s needs.

Duties and Responsibilities / Essential Functions:

• Lead the research, setup, and testing of new payer data, including reimbursement terms, claim requirements, and filing deadlines, within the Universal Payer Database.
• Partner with internal users across the organization to troubleshoot and resolve payer data issues efficiently.
• Communicate directly with insurance payers via phone and email to verify, clarify, and update contract information.
• Audit and maintain the accuracy of information on the company intranet and securely manage user access for various payer web portals.
• Maintain a professional workspace and adhere to regular, predictable attendance standards to support high-volume operations.

 Work Environment:

 This role operates in a professional corporate office or an approved, secure, and HIPAA-compliant home office. The position routinely requires the use of standard digital office equipment and productivity tools.

Physical Demands:

 The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Remaining in a stationary position at a desk for prolonged periods, with the flexibility to sit or stand.
• Constantly operating a computer, keyboard, and other standard digital office productivity tools.
• Constantly viewing a computer terminal to read, analyze, and process high volumes of information for extended periods.
• Frequently communicating and exchanging accurate information with internal stakeholders, business partners, clients, and employees.

Required Education, Experience & Competencies:

• High School Diploma or equivalent required.
• A 2-year degree in Business or Healthcare Administration is preferred.
• 1–2 years of medical office experience required.
• Direct experience with Durable Medical Equipment (DME), documentation requirements, insurance policy guidelines, and medical billing is highly preferred.
• Professional certifications in Microsoft Office or Adobe Acrobat are preferred.
• Solid understanding of medical terminology, including modifiers, allowables, Remittance Advice (RA), and Coordination of Benefits (COB).
• Written and verbal communication skills required for professional correspondence with payers and internal teams.