Job Description

About Us

Pinnacle Fertility is a leader in physician-centric fertility care, supporting high-performing fertility clinics and comprehensive service providers nationwide. Guided by our mission of fulfilling dreams by building families, Pinnacle offers compassionate care, innovative technology, and comprehensive fertility treatment services to provide patients with a seamless and personalized journey to parenthood. Learn more at www.pinnaclefertility.com

About the Role

The Payer Strategy Specialist supports Pinnacle Fertility’s financial performance by ensuring accurate reimbursement, monitoring payer and regulatory changes, and overseeing payer enrollment requirements. This role conducts payment and fee schedule audits, performs regional fee comparisons, and provides analytical insights that strengthen payer strategy and reduce preventable denials.

The Specialist plays a key role in maintaining strong payer relationships, supporting issue resolution, and collaborating across Revenue Cycle, Coding, Denials, and Operations to ensure compliance with payer rules and evolving regulatory requirements. This position is critical to maintaining a stable, well-informed payer environment as Pinnacle continues to grow.

We are seeking a Payer Strategy Specialist to join our dedicated team at Pinnacle Fertility – Arizona in Scottsdale, AZ. This is a full-time, onsite position, working Monday through Friday from 8:30 AM to 5:00 PM.

Key Responsibilities

• Conduct detailed payer payment variance audits to identify underpayments and overpayments.
• Analyze trends in payment discrepancies and recommend corrective actions.
• Partner with Payment Posting on corrections, recoveries, and payer escalations.
• Perform fee schedule audits to confirm accurate system loading and appropriate reimbursement.
• Conduct regional fee comparisons across Pinnacle markets to evaluate reimbursement differences and identify opportunities for alignment or negotiation.
• Maintain internal fee schedule documentation and validate updates during payer changes or contract adjustments.
• Support data modeling to identify payer reimbursement gaps or anomalies.
• Monitor payer policy updates, including reimbursement methodologies, coding changes (CPT/HCPCS), modifier rules, and medical necessity edits.
• Assess the operational and financial impact of payer updates and issue timely guidance to Coding, Posting, Denials, and Operations.
• Maintain an internal knowledge base of payer rules and updates.
• Verify accurate payer enrollment setup for new and existing providers to prevent enrollment-related denials.
• Monitor payer enrollment timelines, updates, and requirements and ensure internal systems reflect the latest payer expectations.
• Coordinate with stakeholders to resolve enrollment discrepancies promptly.
• Provide analytical insights to support payer discussions, contract reviews, and strategic initiatives.
• Educate internal teams on payer rules, reimbursement changes, and policy updates.
• Build and maintain strong working relationships with payer representatives and facilitate discussions related to enrollment, reimbursement, policy clarification, and claims trends.

Position Requirements

• Education: Bachelor’s degree in healthcare administration, business, or related field preferred; equivalent experience considered.
• Experience: 2–4 years of experience in payer analytics, revenue cycle, reimbursement review, or payer operations.

Skills:

• Strong analytical skills with the ability to translate data into actionable recommendations.
• Familiarity with payer enrollment, fee schedules, and reimbursement methodologies.
• Working knowledge of CPT/HCPCS coding and payer billing rules preferred.
• Excellent communication skills and ability to collaborate cross-functionally.
• Experience with fertility, specialty, or outpatient healthcare services preferred.
• Ability to manage multiple priorities independently in a fast-paced environment.

Compensation & Benefits

• Hourly Rate: $29.00 – $38.00 per hour (final offers based on experience, skills, and qualifications).

• Benefits: Pinnacle Fertility offers a comprehensive benefits package including medical, dental, vision, and life insurance. Additional benefits include generous paid time off, paid holidays, and a retirement savings program. Further details will be provided during the interview process.

Diversity & Inclusivity at Pinnacle Fertility

At Pinnacle Fertility, we are committed to fostering a diverse, inclusive, and welcoming workplace. We are proud to be an equal opportunity employer and encourage applicants of all backgrounds, abilities, and life experiences to apply.