Overview
This role involves serving as a Claims Payables Specialist responsible for processing and adjudicating value-based care claims. The position ensures compliance with internal policies and regulatory standards, maintaining the accuracy and integrity of claims payments. The specialist contributes to the efficiency of healthcare reimbursement by collaborating with various departments and managing provider relationships.
Responsibilities
- Process and adjudicate value-based care claims following established policies, procedures, and regulatory requirements.
- Review claims for accuracy, completeness, and compliance with contractual agreements and reimbursement guidelines.
- Investigate and resolve discrepancies in claim information by working with internal and external partners.
- Ensure timely and accurate payment of claims, including calculating and applying appropriate reimbursement rates and adjustments.
- Maintain detailed documentation of claims processing activities, including status updates, payment records, and correspondence.
- Collaborate with provider relations, contracting, and finance teams to address claim-related inquiries and issues.
- Assist in developing and implementing process improvements to optimize claims processing workflows.
- Stay informed about industry trends, regulatory changes, and best practices related to value-based care reimbursement and claims processing.
- Participate in training programs to enhance knowledge and skills related to claims processing and value-based care.
- Support ad-hoc projects and initiatives as assigned by leadership.
Compensation
- Salary range: $50,000 - $70,000
Location
Not specified.