Post Payment Claims Specialist

Reliant Health Partners, LLC; United States; Remote; USD 50,000 - 60,000; Full time

Benefits offered by this job

Comprehensive medical, dental, vision,

401(k) with employer match

HSA & FSAs

Paid time off and disability leave

Employee Assistance Program (EAP)

Job summary

Reliant Health Partners is seeking a Post Payment Claims Specialist to educate providers on NSA processes, respond to appeals, and negotiate post payment claims to resolve payment disputes. You will manage post payment queues, conduct outreach calls, and ensure HIPAA compliance.

Strong candidates have 2–3 years in appeals/negotiations and experience with claims workflow tools. Compensation ranges from $50,000 to $60,000 USD plus benefits.

Qualifications

• 2–3 years of related job experience – appeals, negotiations, medical billing.
• Experience conducting outreach to providers via phone calls or other communication means.
• Broad healthcare policy and payment understanding.
• Experience with claims workflow tools or systems.

Responsibilities

• Monitor and manage post payment queues.
• Conduct outreach, education, and negotiation calls to providers for post payment claims.
• Verify/confirm understanding of NSA claims payments and regulations with providers.
• Explain claim payments for various pricing products to providers.
• Maintain compliance, including Confidentiality and HIPAA requirements.

Skills

Appeals

Negotiations

Medical Billing

Provider Outreach

Tools

Claims workflow tools

Job description

Reliant Health Partners is an innovative medical claims repricing service provider, helping employers achieve maximum health plan savings with minimum noise. We tailor our services to each client’s needs, providing everything from individual specialty claims repricing, to full plan replacement as a high-performance, open-access network alternative.

As a Post Payment Claims Specialist, you are responsible for contacting providers to educate on NSA process/payments, respond to appeals for various products, and negotiate these post pay appealed claims to resolve payment disputes.

Primary 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.

Qualifications:

• 2-3 years of related job experience – appeals, negotiations, medical billing.
• Experience conducting outreach to providers via phone calls or other communication means.
• Broad healthcare policy and payment understanding.
• Experience with claims workflow tools or systems.

Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

Pay Transparency

$50,000 - $60,000 USD

• 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)

Equal Employment Opportunity: At Reliant, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Reliant Health Partners is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Reliant’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.