Hospital Claims Relationship Specialist Job at Healthfirst

Contract Manager, Hospital Negotiations

The Contract Manager, Hospital Negotiations serves as an integral member of the ...

Location

United States of America , Cleveland or Independence, OH

Salary:

92000.00 - 153300.00 USD / Year

The Cigna Group

Expiration Date

Until further notice

Requirements

3+ years Hospital 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
Demonstrates managerial courage as well as an ability to maneuver effectively in a changing environment
Superior problem solving, decision-making, negotiating skills, contract language and financial acumen

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
Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements
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 “HCP” agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners

What we offer

Annual bonus plan
Health-related benefits including medical, vision, dental, and well-being and behavioral health programs
401(k)
Company paid life insurance
Tuition reimbursement
A minimum of 18 days of paid time off per year
Paid holidays

Fulltime

Provider Contracting Advisor

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

Location

United States of America , Columbus, OH

Salary:

92000.00 - 153300.00 USD / Year

The Cigna Group

Expiration Date

Until further notice

Requirements

Bachelor's Degree preferred. Industry experience will be considered in lieu of a 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.
Demonstrates an ability to maneuver effectively in a changing environment.

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.

What we offer

Annual bonus plan.
Health-related benefits including medical, vision, dental, and well-being and behavioral health programs starting day one.
401(k)
Company paid life insurance
Tuition reimbursement
A minimum of 18 days of paid time off per year
Paid holidays.

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

New

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
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
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

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
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
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

Fulltime

Patient Financial Specialist - Patient Financial Services

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
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
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

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

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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