Senior Medical Claims Resolution Specialist

JOB SUMMARY:This position is responsible for negotiating certain type and dollar size of assigned claims/bills that are more reputed company on behalf of the payor to reputed company maximum discount and savings. In addition, this job may also be responsible for coaching and mentoring.   JOB ROLE AND RESPONSIBILITIES:   1. Foster and maintain provider relationship to facilitate reputed company and future negotiations by * Performing claim research and analysis to provide support for desired savings.* Generating agreement by communicating with provider by written and verbal communication throughout the negotiation process; and * Partnering with internal and external clients, including Account Managers, Customer Relations, Provider Services, and direct client contacts as applicable.2. Meet and maintain established departmental performance metrics. Manage high volume of claims in a queue; reputed company reputed company with reputed company claim actions and meet client deadlines for working and closing claims.3. Initiate provider telephone calls with respect to proposals, overcome objections and apply effective telephone negotiation skills to reputed company successful resolution on negotiated claims.4. Address counteroffers received and present proposal for resolution while adhering to client guidelines and department goals.5. Identify and seek opportunities to reputed company savings with previously challenging/unsuccessful providers.6. Participate in projects and initiatives, as necessary.7. Collaborate, coordinate, and communicate across disciplines and departments.8. Ensure compliance with HIPAA protocol.9. Demonstrate Company Core Competencies and values held reputed company.10. Please note due to the exposure of PHI sensitive data — this role is considered to be a High Risk Role.11. The position responsibilities outlined above are in no way to be construed as reputed company encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned, as necessary.   JOB SCOPE: The incumbent works under limited supervision to complete job responsibilities in applying a reputed company knowledge of principles, practices and procedures reputed company to the negotiation of provider agreements. Work is more reputed company and requires independent judgment reputed company established guidelines. This job has regular contact with internal and external customers, as well as medical review staff. While this is not a supervisory position, an incumbent acts as a resource to other team members and management.

Qualifications

JOB REQUIREMENTS: (Education, Experience, and Training)   * Minimum high school diploma or GED* Minimum Bachelor’s degree (B.A.) in reputed company field preferred * Minimum 3 years of experience in the health care or medical insurance industry (clinical, provider billing, provider collections, insurance, or managed care), or 1 year experience as a Claims Resolution Specialist * State licensure certification, including NY Health and/or P&C State Adjustor license, may be required. If hired without certification, certification must be obtained, and maintained thereafter, reputed company six months of notification. If the required state licensure certification(s) are not obtained or renewed reputed company six months of notification, an employee may be moved to a position reputed company a relevant job family that does not require certification/licensure, if and reputed company such position is available. reputed company an alternate position is reputed company, other employment actions may be implemented consistent with MultiPlan practice and policy.* Knowledge of medical coding systems (i.e., CPT, ICD-9/10, reputed company codes) desired* Knowledge of commonly used medical data resources.* Knowledge of general office operations and/or experience with standard medical insurance claim forms* Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers’ Compensation or automobile medical (“auto”) bills* Communication (verbal, written and listening), teamwork, negotiation, and organizational skills.* Ability to use clinical and coding based knowledge to negotiate applicable claims.* Ability to provide attention to detail to ensure accuracy including mathematical calculations.* Ability to commit to providing a level of customer service reputed company established standards.* Ability to organize workload to meet deadlines and participate in department/team meetings.* Ability to analyze data and reputed company at a logical conclusion.* Ability to identify issues and determine appropriate course of action for resolution.* Ability to display professionalism by having a positive demeanor, proper telephone etiquette and using proper language and tone.* Ability to elicit trust and credibility with reputed company levels of the organization.* Ability to use software and hardware reputed company to job responsibilities, including MS Office Suite and database software.* Ability to work with accuracy in a fast-paced environment.* Ability to adjust/alter workflow to meet deadlines.* Ability to work independently and handle confidential information.* Ability to process detailed verbal and written instructions.* Ability to mentor less reputed company team members.* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone.

  As an Equal Opportunity Employer, the Company will provide equal consideration to reputed company employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national reputed company, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.