Payer Configuration Specialist - Military veterans preferred

The Payer Configuration Specialist serves as a critical bridge between the Billing and Collections teams, ensuring efficient payer setup, accurate claim submission, and timely reimbursement. This role requires deep knowledge of healthcare related accounting, AR software, state portals, healthcare insurance companies, and payer rules. The Specialist supports both teams through training, troubleshooting, special projects, and high-effort tasks that impact revenue cycle performance. The position plays a key role in reducing denials, resolving claim issues, collecting cash and driving process improvements to strengthen overall AR operations. 

Key Responsibilities 

• Research and resolve denied or underpaid claims, ensuring proper resubmission and appeals when necessary.
• Verify payer configurations to support clean claim submission and accurate reimbursement.
• Communicate with insurance representatives to clarify claim statuses, coverage issues, and payment discrepancies.
• Assist with the development and delivery of training for Billing and Collections team, ensuring alignment on payer rules and system workflows.
• Serve as a subject matter expert for payer portals, insurance requirements, and AR system configurations.
• Provide one-on-one guidance and coaching for complex claims or payer issues.
• Lead or participate in special projects, including payer migrations, system upgrades, and process redesign initiatives.
• Analyze payer trends to identify recurring issues and recommend workflow improvements to reduce denials and delays.
• Maintain accurate documentation of all claim activity, payer configuration changes, and collection efforts.
• Collaborate with billing, coding, and administrative teams to resolve claim issues and prevent recurring denials.
• Ensure compliance with HIPAA, state regulations, and payer requirements in all billing and collection activities.

Qualifications 

• 3+ years of experience in Accounts Receivable, Medical Billing, or Collections, with direct experience working with Medicare, Medicaid, and commercial insurance payers
• Strong knowledge of insurance billing processes, payer requirements, claim resolution, and denial management.
• Proficiency with billing software, and AR systems.
• Exceptional analytical and problem-solving skills with a strong attention to detail.
• Strong communication skills, with the ability to interact professionally with patients, insurance representatives, and internal staff.
• Ability to manage multiple priorities, meet deadlines, and adapt in a fast-paced environment.

Language Skills: Ability to read, analyze, and interpret general health and social services guidelines, technical procedures or governmental regulations. Ability to write reports, health correspondence and procedure manuals. Ability to effectively present information and respond to questions from groups or patients, center staff, and the general public. 

Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions. 

Customer Relationships: Follow through with customer inquiries, requests and complaints. Forward difficult and non-routine inquiries or requests to appropriate level for resolution.  

Work Environment: This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. 

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. This is largely a desk-bound role with typical office noise; however, frequent movement throughout the office is required. Frequent sitting, standing, and walking are daily activities. Some bending and filing may be required (<10% of time). This would require the ability to lift files (<10 lbs.), open filing cabinets and bend or stand as necessary. Over 2/3 of Time: See; Sit; Use hands to finger/handle/feel; Talk or Hear. 

Position Type: This is a full-time, non-exempt-level position based at Corporate headquarters. 

Equal Opportunity Statement:
At GA Foods, we are deeply committed to the principles of equal employment opportunity. It is our policy that all employment decisions are made without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetics, disability, veteran status, or any other characteristic protected by local, state, or federal law. We base all employment decisions on merit, qualifications to perform the essential job functions (with or without reasonable accommodations), and business needs. GA Foods also provides affirmative action in employment for qualified individuals with disabilities and protected veterans, in compliance with Section 503 of the Rehabilitation Act and the Vietnam Era Veterans' Readjustment Assistance Act.

GA Food Services of Pinellas County, LLC (GA Foods) is proud to be a Drug-Free, Smoke-Free Workplace and an Equal Employment Opportunity Employer.