Claims Payables Specialist

Responsibilities

• Process and adjudicate value-based care claims in accordance with established policies and regulatory requirements
• Review processed claims for accuracy, completeness, and compliance with contractual agreements
• Investigate and resolve discrepancies in claim information with internal and external partners
• Ensure timely and accurate payment of claims, including calculation of reimbursement rates
• Maintain thorough documentation of claims processing activities and payment records
• Collaborate with provider relations, contracting, and finance departments
• Assist in developing process improvements to optimize claims workflows
• Stay updated on industry trends and regulatory changes in value-based care

Requirements

• Minimum of 2 years of experience in claims processing, preferably in healthcare reimbursement
• Proficiency in claims processing systems and EDI technology
• Understanding of value-based care models and reimbursement strategies
• Strong analytical skills to resolve claims discrepancies
• Detail-oriented with a commitment to accuracy and compliance
• Knowledge of healthcare regulatory and compliance standards

Preferred Qualifications

• Bachelor’s degree in finance, accounting, healthcare administration, or a related field
• Certification in healthcare billing or claims management

Benefits

• Competitive base compensation and annual bonus potential
• Health benefits effective on start date
• Health & Wellness Program (up to $300 per quarter)
• 401K plan with 100% match up to 4%
• 5 sick days and generous paid "Vytal Time"
• Company paid STD/LTD
• Technology setup provided