Post Payment Claims Specialist
About The Position
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 Medical Claims Appeal 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.
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.
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 not 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.
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)
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
11-50 employees
