Hospital Claims Relationship Specialist Job at Healthfirst

Provider Contracting Manager

The Provider Contracting Manager serves as an integral member of the Provider Co...

Location

United States of America , Sunrise

Salary:

Not provided

The Cigna Group

Expiration Date

Until further notice

Requirements

Should possess a bachelor’s degree
preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a bachelor’s degree. MBA or MHA preferred
3+ years Managed Care contracting and negotiating experience involving complex delivery systems and organizations required
Experience in developing and managing key provider relationships
Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred
Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
Intimate understanding and experience with hospital, managed care, and provider business models
Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
Customer centric and interpersonal skills are required

Job Responsibility

Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy
Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service
Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution
Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position
Creates and manages initiatives that improve total medical cost and quality
Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives
Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms
Creates healthcare provider agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners
Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues

Provider/Hospital Contracting Manager

The Provider/Hospital Contracting Manager serves as an integral member of the Pr...

Location

United States of America , Hartford

Salary:

Not provided

The Cigna Group

Expiration Date

Until further notice

Requirements

Should possess a bachelor’s degree
preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a bachelor’s degree
MBA or MHA preferred
3+ years Managed Care contracting and negotiating experience involving complex delivery systems and organizations required
Experience in developing and managing key provider relationships
Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred
Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
Intimate understanding and experience with hospital, managed care, and provider business models
Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations

Job Responsibility

Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups)
Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy
Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service
Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution
Works to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position
Creates and manages initiatives that improve total medical cost and quality
Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives
Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms
Creates healthcare provider agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners
Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues

Accounts Payable Specialist

As part of the EMEA Finance Business Process & Transformation team this role ens...

Location

United Kingdom , London

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

Fluency in English required
Proficiency in Peoplesoft including AP, OFB, General Ledger and EPM applications is a distinct advantage
Knowledge of internal Marriott accounting practices (preferred)
Solid knowledge of accounting principles and practices, including VAT / GST and other local Sales taxes required
Ability to work in a multi-currency environment
Advanced Excel proficiency
Ability to lead processes to meet ad-hoc and reoccurring deliverables
Trustworthy with strong business integrity and ability to hold sensitive information in confidence
Effective problem-solving abilities: recognizes and researches problems and identifies their underlying causes and recommends and implements solutions
Excellent organizational skills

Job Responsibility

Ensures the accurate and timely execution of accounts payable processes at EMEA’s administrative offices
Input and payments of invoices received by the EMEA’s administrative offices
Requesting vendor set-up
Auditing, and tracking of expense claims
Liaising with Accenture Hospitality Services (AHS)
Assisting with the administration of the corporate credit card program
Responding to vendor and accounts payables queries and requests
Ensuring compliance with Marriott International Policies, International and Local Standard Operating Procedures (MIPs, ISOPs and LSOPs)
Assists with month end procedures and balance sheet reconciliations
Provides technical expertise and direction to support other Finance teams as well as the business with disbursement related issues

Fulltime

Patient Financial Specialist

The associate is responsible for the duties and services that are of a support n...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

HS Diploma or equivalent years of experience required
Post HS education preferred
1-3 years of experience preferred
Experience working within a multi-facility hospital business office environment preferred
College education, previous Insurance Company claims experience, and/or health care billing trade school education may be considered in lieu of formal hospital experience
Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred
Experience with Medicare & Medicaid billing processes and regulations preferred
Understanding of Medicare language
Knowledge in locating and referencing CMS and/or Medicare Regulations preferred

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics
Ensures PFS departmental quality and productivity standards are met
Collects and provides patient and payor information to facilitate account resolution
Maintains an active working knowledge of all Government Mandated Regulations as it pertains to claims submission
Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission
Responds to all types of account inquires through written, verbal, or electronic correspondence
Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers
Maintains working knowledge of all functions within the Revenue Cycle
Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution

Fulltime

Patient Financial Specialist

The associate is responsible for the duties and services that are of a support n...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

HS Diploma or equivalent years of experience required
Post HS education preferred
1-3 years of experience preferred
Experience working within a multi-facility hospital business office environment preferred
College education, previous Insurance Company claims experience, and/or health care billing trade school education may be considered in lieu of formal hospital experience
Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred
Experience with Medicare & Medicaid billing processes and regulations preferred
Understanding of Medicare language
Knowledge in locating and referencing CMS and/or Medicare Regulations preferred

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics
Ensures PFS departmental quality and productivity standards are met
Collects and provides patient and payor information to facilitate account resolution
Maintains an active working knowledge of all Government Mandated Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission
Responds to all types of account inquires through written, verbal, or electronic correspondence
Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within the Revenue Cycle
Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution
Meets or exceeds customer expectations and requirements, and gains customer trust and respect
Compliant with all CHRISTUS Health, payer, and government regulations

Fulltime

Ambulance Coder

Essential Duties and Responsibilities: Researches all information to complete ac...

Location

United States , Oklahoma City

Salary:

Not provided

Pafford EMS

Expiration Date

Until further notice

Requirements

Knowledge of procedure and diagnostic codes (HCPCS and ICD-10 codes)
Knowledge of medical terminology
Knowledge of state and federal insurance regulations
Ability to analyze and problem solve complex issues
Knowledge of billing requirements, coverage and benefits
Uphold Medicare, Medicaid and HIPAA guidelines
Knowledge of Medical Billing
Ability to work independently and with a group
Working knowledge of MS Word, Excel
Ability to maintain effective working relationships

Job Responsibility

Researches all information to complete accurate billing processes including assignment of billing charge codes and ICD-10 diagnosis codes
Prioritize workflow to ensure timely claim submission
Identifies and communicates documentation issue trends
Utilize various resources to locate insurance payers for ambulance transportation
Contact the hospital, patient’s family, and/or patient to obtain insurance information
Fax partner hospitals requests for information
Validate and update patient demographics in the practice management system
Responsible for the accurate entry of data into the practice management system
This position requires specialist to spend extended periods of time on the phone with insurance companies
Reports quality and documentation issues to the department head

Care Management Specialist II

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Care Management Specialist II, D-SNP Team

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Hospital Claims Relationship Specialist

Healthfirst

Location:
United States

Category:
Insurance

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
January 08, 2026

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Nice to have:

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