Accounting & Provider Relations Payment Specialist (Remote)
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Job Description
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
Automate your job search with Sonara.
Submit 10x as many applications with less effort than one manual application.
