Post Payment Claims Specialist
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Job Description
Medical Claims Appeal Specialist resolving payment disputes and educating providers on NSA claims at Reliant Health Partners. Handling outreach and compliance in a remote setting.
Responsibilities:
- Monitor and manage your post payment queues.
- Conduct outreach, education, and negotiation calls to providers for post payment claims.
- Effectively communicate with providers to verify/confirm understanding of NSA claims payments and regulations.
- Effectively communicate with providers to explain claim payments for various pricing products.
- Maintain compliance, including but not limited to Confidentiality and HIPAA requirements.
- Maintain acceptable levels of production including but limited to turn around time standards as mandated by the regulation(s).
- Document all conversations and record name, phone number, and email of contact person if available, payment rates offered on behalf of clients, and any counter offers by the provider.
- Adhere to client specific and Reliant protocols, scripts, and other requirements.
- Develop a comprehensive understanding of the state and federal regulations that will impact payments to providers.
- Develop a comprehensive understanding of our various products.
- Perform other job-related duties and special projects as required.
Requirements:
- 2-3 years of related job experience – appeals, negotiations, medical billing.
- Experience conducting outreach to providers via phone calls or other communication means.
- Experience understanding Reliant critical behaviors and compliance requirements.
- Broad healthcare policy and payment understanding.
- Experience with claims workflow tools or systems.
Benefits:
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
- Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
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