Accounting & Provider Relations Payment Specialist

Accounting & Provider Relations Payment Specialist

About the Role

We're hiring a cross-trained Accounting & Provider Relations Payment Specialist to support our third-party administrator (TPA) operations across both accounting/payroll functions and provider claims payment support. This is a zoned, cross-trained position — you'll build proficiency across multiple areas so you can flexibly cover where needed.

Key Responsibilities

• Research and respond to Customer Service and Account Manager payment status requests
• Follow up on and confirm missing claims on payment submissions
• Research and resolve aged claims
• Process GLP-1 reimbursements
• Assist providers with payment portal access and related questions
• Support expanded payment processing responsibilities (funding confirmation, payment submission approval, monitoring available funds) as the role grows
• Interpret plan documents, summary plan descriptions (SPDs), and administrative services agreements
• Maintain accurate documentation of claims activity and communications
• Identify and escalate recurring issues, billing discrepancies, or complaints
• Ensure compliance with ERISA, HIPAA, and state prompt-pay laws
• Support internal and client-facing audits with documentation and status updates
• Process and manage staff payroll
• Maintain QuickBooks proficiency for day-to-day accounting tasks
• Support the organization's transition to state-audited financial practices
• Coordinate with external accountants as needed

Qualifications

• QuickBooks proficiency
• Experience with state-audited financial institutions/practices (CPA not required)
• Background in finance, including staff payroll
• Experience coordinating with external accountants
• Prior experience in claims processing, medical billing, or provider relations within a TPA, health plan, or self-funded plan environment strongly preferred
• Strong Excel skills (formulas, pivot tables, data sorting/filtering)
• Familiarity with plan documents, SPDs, and self-funded benefit structures
• Working knowledge of claims adjudication systems and healthcare billing/coding practices (CPT, ICD-10, HCPCS)
• Proficiency with Microsoft Office (Outlook, Word) and claims administration software

Skills & Competencies

• Strong discretion and sound judgment with sensitive financial, payroll, and plan participant information
• Excellent verbal and written communication skills
• Strong attention to detail and accuracy across a multi-client, multi-plan environment
• Ability to manage multiple priorities and deadlines
• Problem-solving skills to research and resolve discrepancies across varied plan designs
• Ability to work independently and collaboratively in a fast-paced, multi-client TPA environment