Payment Integrity Specialist
Overview
Who We Are Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com.
Responsibilities
Ready to The role is responsible for managing complex healthcare claim negotiations and ensuring compliance with federal regulations. What You'll Actually Do The role is responsible for managing complex healthcare claim negotiations and ensuring compliance with federal regulations. Essential Functions/Responsibilities/Duties · Complete No Surprise Act Negotiations and defend employer groups in the NSA and IDR appeal process. · Review Itemized Bills and prepare them for physician review including OCR and Spreadsheet entry and formatting. · Prepares and negotiate settlements with providers · Follows up with providers on unsigned settlements. · Releases claims in the various TPA systems. · Assist with SCA negotiations.
Qualifications
What You Bring to Our Team Education and Experience · At least 5 years of experience in a TPA, Payment Integrity, Revenue Cycle management, and/or coding. · High school diploma. · Knowledge of medical terminology and medical billing terminology. · Experience with Excell, OCR, and strong software and technical proficiency Required Knowledge, Skills, and Abilities · Attention to detail and organizational efficiency · Ability to manage multiple stakeholders and deadlines · Strong negotiation and dispute resolution skills · Self-starter and self-motivated.
Work Environment
At Personify Health we value and celebrate diversity, and we are committed to creating an inclusive environment for all employees. We believe in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce better solutions. But more than this, diversity is our strength, and a catalyst in our ability to change lives for the good. Physical Requirements · Must be able to remain in a stationary position 50% of the time. · The person in this job needs to occasionally move about inside the office to access office machinery, filing cabinets and meeting facilities. · Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc. · Frequently positions self to maintain files in file cabinets. · Frequently moves boxes or equipment weighing up to 25 pounds. · Must communicate information and ideas so others understand. Must be able to exchange accurate information in these situations. · Must be able to observe details at close range.
Benefits
The Highlights: Competitive base salary and benefits effective day one Comprehensive medical and dental through our own health solutions (yes, we use what we build) Paid Time Off—rest and recharge time is non-negotiable Mental health support, retirement planning, and financial protection Professional development with clear career progression and learning budgets Mission-driven culture where diverse perspectives drive real impact on people's health Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Compensation: This position offers a base salary range of $23-$26 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one. Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing. Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to [email protected]. View all legitimate openings at personifyhealth.com/careers. Apply To This Job