Provider Services Specialist

About Green Light:

Green Light is a fast-growing healthcare technology company dedicated to transforming the industry through innovation and service. We're seeking an energetic and knowledgeable Appeals Specialist who thrives in a dynamic environment and is ready to make a meaningful impact, especially someone with strong experience handling No Surprises Act (NSA) claims and disputes.

Job Summary:

As an Appeals Specialist at Green Light, you’ll play a critical role in managing provider appeals, resolving reimbursement issues, and overseeing processes under the No Surprises Act (NSA). Your experience with Open Negotiations and Independent Dispute Resolution (IDR) will be key to ensuring timely, compliant, and accurate claim resolutions. We’re looking for someone who’s proactive, detail-oriented, and excels at managing relationships with both providers and internal stakeholders.

Responsibilities:

• Handle inbound calls and communications from provider billing offices regarding claim reimbursement issues and benefit determinations.


• Serve as the primary point of contact for appeals under the No Surprises Act, overseeing the Open Negotiation and IDR process from beginning to end.


• Conduct thorough research on appeal cases to determine appropriate next steps in compliance with NSA and client policies.


• Communicate clearly and professionally with healthcare providers, internal teams, and client representatives regarding claims processing and resolution.


• Draft and manage Appeal Settlement Agreements, maintaining accurate records throughout the appeal lifecycle.


• Ensure adherence to HIPAA protocols and company compliance standards.


• Coordinate across teams to facilitate timely settlements and effective information flow.


• Monitor timelines to ensure NSA-related cases are managed within statutory and contractual deadlines.
  

Qualifications:

• Minimum of 1 year of experience working under the requirements of the No Surprises Act and/or handling LOA/SCA, Grievances and Appeals, or Claims Processing.


• 3–5 years of healthcare customer service experience, preferably in billing or claims.


• Working knowledge of medical coding and healthcare terminology.


• Excellent communication skills—both verbal and written.


• Strong organizational skills and ability to manage multiple cases simultaneously.


• High school diploma or equivalent required; associate or bachelor’s degree a plus.


• Familiarity with HIPAA regulations.