Provider Relation Specialist
Job description
About Alaffia & Our Mission
The U.S. healthcare system suffers from over $300B in improper payments each year due to fraud, waste, abuse, and processing errors. We’re on a mission to change that. To best prevent inaccurate payments, we’ve assembled a team of experienced technologists and industry-leading healthcare domain experts. The Alaffia team has alumni ranging from Amazon, Goldman Sachs, the Centers for Medicare and Medicaid Services, and other leading healthcare and financial institutions. We’re also backed by industry-leading venture capital firms!
If you want to make a major impact at the core of U.S. healthcare by implementing the latest in cutting-edge technologies, then we’d like to meet you.
Our Culture
At Alaffia, we fundamentally believe that the whole is more valuable than the sum of its individual parts. Further to that point, we believe a diverse team of individuals with various backgrounds, ideologies, and types of training generates the most value. Our people are entrepreneurial by nature, problem solvers, and are passionate about what they do — both inside and outside of the office.
About the Role & What You’ll Be Doing
Alaffia’s core goal is to provide cutting-edge Payment Integrity Services to our clients. As such, we’re looking for a detail-oriented individual who loves collaboration and thrives in a client/provider-facing role. You will work alongside our Payment Integrity Solutions teams to guide claim review results for both internal and external use. You will break down complex edits by creating an understandable reporting package that may be shared with providers as well as clients. In this role, you’ll have the opportunity to drive real social and economic change by tackling fraud, waste, and abuse in the healthcare industry.
Your primary goal is to help our clients reduce their healthcare spending through provider education and understanding of industry-standard guidelines. You will be expected to meet and exceed all key performance indicators in the below areas of responsibility and requirements.
Your Responsibilities
- Serve as the primary liaison between healthcare payers & providers in this external facing role
- Coordinate with healthcare providers to resolve complex claim-related issues
- Ability to think clearly and discuss claim discrepancies in a calm, friendly manner
- Collaborate with our Payment Integrity teams to understand and effectively communicate analysis results
- Acquire knowledge of specific medical claims payments to better understand the negotiation process
- Create customized agreements and reporting packages based on findings and negotiated rates
- Update information on internal systems on behalf of providers and clients
What We’re Looking For
- Bachelor’s degree preferred or relevant industry experience
- 3+ years of professional experience in provider relations or account management
- General familiarity with health insurance and medical billing preferred
- Excellent presentation, oral and written communication skills
- Able to prioritize tasks and manage multiple deadlines
- Experience building and expanding relationship databases
- Must be detail-oriented and flexible to work in a fast-paced, dynamic environment
- Access to high-speed internet
- Nice to haves:
- Prior experience in contract negotiations
- Prior experience with self-funded health plans
- Prior experience working at a healthcare company or plan administrator
Our Culture
At Alaffia, we fundamentally believe that the whole is more valuable than the sum of its individual parts. Further to that point, we believe a diverse team of individuals with various backgrounds, ideologies, and types of training generates the most value. Our people are entrepreneurial by nature, problem solvers, and are passionate about what they do — both inside and outside of the office.
If you want to work alongside driven people on a mission to make a major impact at the core of U.S. healthcare by implementing the latest in cutting-edge technologies, then we’d like to meet you!
Salary Range
$50,000-$70,000 annual salary
What Else Do You Get Working With Us?
- Competitive base salary
- Unlimited PTO
- Medical, Vision, and Dental benefits
- Work in a flat organizational structure — direct access to Leadership
