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.
Vytalize Health is an all-in-one solution ACO for independent primary care physicians participating in value-based care with Medicare.
Key team members
Will Weisman
James Franke
Tom Wilson
Omar Elrabie
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