Claims Payables Specialist

What You Will Do

• Process and adjudicate value-based care claims in accordance with established policies, procedures, and regulatory requirements.
• Review processed claims for accuracy, completeness, and compliance with contractual agreements and reimbursement guidelines.
• Investigate and resolve discrepancies or discrepancies in claim information, working collaboratively with internal and external partners as needed.
• Ensure timely and accurate payment of value-based care claims, including the calculation and application of appropriate reimbursement rates and adjustments.
• Maintain thorough and accurate documentation of claims processing activities, including claim status updates, payment records, and correspondence with providers and payers.
• Collaborate with other departments, including provider relations, contracting, and finance, to address claim-related inquiries, issues, and concerns.
• Assist in the development and implementation of process improvements and efficiency initiatives to optimize claims processing workflows.
• Stay abreast of industry trends, regulatory changes, and best practices related to value-based care reimbursement models and claims processing.
• Participate in training and educational programs to enhance knowledge and skills related to claims processing and value-based care initiatives.
• Support ad-hoc projects and initiatives as assigned by the Senior Manager of Claims Payables or other members of the leadership team.

What You Will Need

• Bachelor’s degree in finance, accounting, healthcare administration, or related field preferred.
• Minimum of 2 years’ experience in claims processing, preferably in value-based care or healthcare reimbursement.
• Certification in healthcare billing or claims management is a plus.
• Proficient in claims processing systems and EDI technology.
• Understanding of value-based care models and reimbursement strategies.
• Ability to analyze and resolve claims discrepancies.
• Strong communication and collaboration skills.
• Detail-oriented with a commitment to accuracy and compliance.
• Able to manage multiple priorities and adapt to changing needs.
• Knowledge of healthcare regulatory and compliance standards.