Payer Operations Specialist

Position Summary
The Payer Operations Analyst plays a critical role in ensuring the accuracy, efficiency, and integrity of payer-related setup and operations across Thriveworks systems. This provider-side position is responsible for translating payer contracts into precise system configurations, managing fee schedules, maintaining high-quality payer data, and supporting operational readiness across Revenue Cycle, Credentialing, and EHR functions.
The ideal candidate is detail-oriented, proactive, and highly skilled in payer configuration workflows, EHR setup, system QA, and payer portal navigation. This role includes regular collaboration with internal partners and a third‑party billing vendor to ensure flawless execution of payer operations.
Key Responsibilities
Payer Configuration & System Management
Implement and maintain payer configuration details (payer IDs, claims routing, EDI enrollment details, billing requirements, plan IDs, etc.) across the EHR and related systems. Support the loading, updating, and auditing of payer fee schedules based on executed contracts, amendments, or updates from payer portals (e.g., Availity, NaviNet, Change Healthcare). Establish and enforce standardized naming conventions for payers, networks, and plans across scheduling tools and EHR systems. Quality Assurance & Data Integrity
Partner with the EHR administration team to configure and test payer setups to ensure proper routing for eligibility, claims, and remittance data. Conduct ongoing QA audits to validate payer configuration accuracy and maintain high-quality system data. Maintain a centralized repository of payer information, including configurations, fee schedules, contact lists, portal credentials, and audit logs. Vendor & Payer Coordination
Collaborate closely with a third‑party billing vendor to share configuration updates, resolve claim routing issues, and ensure alignment on QA routines and operational processes. Monitor payer portals and communications for updates...