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 Negotiate Provider Settlements and Defend Employer Groups Through the NSA and IDR Process? Why This Role Matters The No Surprises Act created new rights for members - and new complexity for the organizations defending them. This role sits at the center of that work: negotiating settlements, managing the IDR appeal process, and making sure employer groups are protected at every stage. When you get a settlement right, it directly impacts plan costs and member outcomes.

What You'll Actually Do

• Lead NSA negotiations and IDR defense: Complete No Surprises Act negotiations and defend employer groups through the NSA and IDR appeal process from initiation through resolution.
• Prepare itemized bills for physician review: Process incoming bills using OCR and spreadsheet entry, formatting them accurately so physician reviewers have what they need to assess charges.
• Negotiate and close provider settlements: Prepare settlement terms, negotiate directly with providers, and follow up on unsigned agreements until they're executed.
• Release claims across TPA systems: Process claim releases in the appropriate TPA platforms once settlements are finalized and approvals are in place.
• Support SCA negotiations: Assist with Surprise Care Act negotiations as needed alongside the primary NSA workload.

Qualifications

What You Bring to Our Team

Education & Experience

• High school diploma required
• 5+ years of experience in a TPA, Payment Integrity, Revenue Cycle Management, and/or coding
• Knowledge of medical terminology and medical billing terminology

Technical Skills

• Proficiency in Excel, OCR tools, and related claims and billing software
• Experience navigating TPA systems for claim processing and release

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 talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.