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.