Payment Operations Associate

Position Summary:

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Capital Rx is seeking a self-driven payment operations associate to support the configuration, and management of provider and member payments for JUDI Health, Capital Rx's enterprise health platform.In year one, this individual will be responsible for the processing and maintenance of medical payments and reports, through third party or internal payments platforms. Thisindividual will also be responsible for assisting customer care for member and provider payment inquiry management, recoupment and adjustment flows, and adhering toprompt-pay timelines.In year two, this individual will be responsible for managing and servicing new and existing clients of JUDI's Medical Claims Adjudication platform. This individual will beexpected to maintain an in-depth understanding of the evolving capabilities of JUDI and our medical network support and client base. Exceptional communication skills and attention to detail are critical for communicating with internal and external stakeholdersto build holistic support for payments processing.

Position Responsibilities:

• Ensure that payments are processed in accordance with standard promptpay timelines and contractual obligations.
• Maintain payments and reporting workflows.
• Build and maintain trusting relationships with clients through superior customer service.
• Provide oversight of future network integrations and client implementation.
• Accountable for accurate and timely transition of new clients into thepayments platform.
• Assist throughout the implementation process, including detailed and strategic guidance for payments infrastructure, processing, reporting, inquiry management, and complex claim situations/requests.
• Proactively identify execution risks and mitigation strategies.
• Provide ongoing stakeholder support to troubleshooting inquiries.
• Identify and drive efficiencies to automate payments flows and reduce risk.
• Certain times of year may require meeting participation, service support or other requirements outside of standard business hours, including weekends.
• Monitor and resolve payment exceptions, returned funds, or rejectedtransactions in a timely manner.
• Ensure HIPAA, ERISA, and other regulatory and client-specificrequirements.
• Responsible for adherence to the Capital Rx Code of Conduct includingreporting of noncompliance.

Minimum Qualifications:

• 1+ years of work experience at a medical payments vendor, health plan,or TPA
• Well-versed in 837 and 835 EDI files
• Well-versed in payment regulations in the medical space including NACHAstandards and CAQH CORE rules
• Well-versed in impact of claims processing and adjudication in regards topayments
• Track record of working in cross-functional initiatives, driving highperformance, meeting deadlines, and executing on deliverables
• Exceptional project / time management, prioritization, and organizationalskills to ensure customer satisfaction
• Ability to shift between competing priorities and meet organizationalgoals
• Proficient in Microsoft office Suite and willing to adapt to software such asJira, Miro, Confluence, Github, and AWS Redshift
• Excellent verbal, written, interpersonal and presentation skills
• Ability to work effectively with virtual teams

Preferred Qualifications:

• Bachelors degree strongly preferred
  Medicare/Medicaid experience preferred