Claims Payables Specialist

Your Opportunity

As a Claims Payables Specialist, you play a pivotal role in the processing and adjudication of value-based care claims, ensuring they comply with both internal policies and regulatory standards. Your focus is on maintaining the integrity and accuracy of claims payments, contributing to the efficiency and reliability of our healthcare reimbursement model. This role requires meticulous attention to detail, a thorough understanding of value-based care agreements, and a commitment to continuous improvement in claims processing. By collaborating with various departments and managing provider relationships, you will ensure claims are processed accurately and efficiently, supporting the financial health of our organization and the satisfaction of our providers.

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.

• Ability to manage multiple priorities and adapt to changing needs.

• Knowledge of healthcare regulatory and compliance standards.

Perks/Benefits

• Competitive base compensation

• Annual bonus potential

• Health benefits effective on start date

• Health & Wellness Program; up to $300 per quarter for your overall well-being available on start date

• 401K plan effective on the first of the month after your start date; 100% of up to 4% of your annual salary

• 5 sick days and unlimited (or generous) paid "Vytal Time" after your first 90 days

• Company paid STD/LTD

• Technology setup

• Ability to help build a market leader in value-based healthcare at a rapidly growing organization

Please note that at no time during our screening, interview, or selection process do we ask for additional personal information (beyond your resume) or account/financial information. We will also never ask for you to purchase anything; nor will we every interview you via text message. Any communication received from a Vytalize Health recruiter during your screening, interviewing, or selection process will come from an email ending in @vytalizehealth.com