Payment Integrity Specialist

Personify Health

23h • Onsite

About The Position

The role is responsible for managing complex healthcare claim negotiations and ensuring compliance with federal regulations. Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.

Requirements

• At least 5 years of experience in a TPA, Payment Integrity, Revenue Cycle management, and/or coding.
• High school diploma.
• Knowledge of medical terminology and medical billing terminology.
• Experience with Excell, OCR, and strong software and technical proficiency
• Attention to detail and organizational efficiency
• Ability to manage multiple stakeholders and deadlines
• Strong negotiation and dispute resolution skills
• Self-starter and self-motivated.

Responsibilities

• Complete No Surprise Act Negotiations and defend employer groups in the NSA and IDR appeal process.
• Review Itemized Bills and prepare them for physician review including OCR and Spreadsheet entry and formatting.
• Prepares and negotiate settlements with providers
• Follows up with providers on unsigned settlements.
• Releases claims in the various TPA systems.
• Assist with SCA negotiations.

Benefits

• Competitive base salary and benefits effective day one
• Comprehensive medical and dental through our own health solutions
• Paid Time Off
• Mental health support
• Retirement planning
• Financial protection
• Professional development with clear career progression and learning budgets
• Mission-driven culture where diverse perspectives drive real impact on people's health

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED