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Post Payment Claims Specialist

United States - Remote

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

As a post payment Claims Specialist, you are responsible for contacting medical providers to educate on NSA process/payments, respond to appeals for various post pay products, and negotiate these post pay appealed claims to resolve payment disputes.  This role will be responsible for ensuring the success of HRGi’s NSA Navigator program, along with State Balance Billing, IA and UCR Plus products.

Responsibilities

  • Monitor and manage your NSA/State/IA/UCR Plus claims list/queue.
  • Conduct outreach, education, and negotiation calls to providers for NSA/State/IA/UCR Plus claims.
  • Effectively communicate with providers to verify/confirm understanding of NSA claims payments and regulations.
  • Effectively communicate with providers to explain claim payments for State/IA/UCR Plus 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 HRGi 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 the IA and UCR Plus products.
  • Perform other job-related duties and special projects as required.

Qualifications

  • 2-3 years of related job experience - medical claim processing, negotiations and or insurance billing.
  • Experience conducting outreach to providers via phone calls or other communication means.
  • Experience understanding HRGi critical behaviors and compliance requirements.
  • Broad healthcare policy and payment understanding.
  • Experience with claims workflow tools or systems.

Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.

Pay Transparency

$50,000 - $65,000 USD

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)

 

Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.

 

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