Claims Resolution Specialist II, Healthcare

MultiPlan

Job Description

 Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company.  We strive to create a workplace that fosters mutual respect and collaboration, where every talented individual can participate and perform their best work.  We are MultiPlan and we are where bright people come to shine! 

Come show off your negotiation skills as a Claims Resolution Specialist in our Fee Negotiations team.   

  • You will have a steady Monday through Friday 40 hour per week schedule between the hours of 7:00 am and 5:00 pm.  Employees are able to pick from available flexible schedules after completing training.
  • Currently, this position is a remote or, work from home, position but will be located in our Arlington, TX (or Naperville, IL w/ geographic pay differential) office when it reopens. 
  • Earn $17.85 per hour ( $18.36 in Naperville, IL) and have the opportunity to receive additional quarterly bonuses based on performance after completion of the training period.
  • We provide equipment needed and an excellent paid virtual classroom training program as well as continuous on the job coaching and mentoring.  We also have advancement and growth opportunities available to employees.
  • Find more information on what it’s like to be a MultiPlan employee on our Careers page at www.multiplan.com
JOB SUMMARY:
This position is responsible for contacting health care providers to negotiate certain type and dollar size health care claims/bills. Objective is to achieve maximum discounts and savings on behalf of the payor/client.
JOB ROLE AND RESPONSIBILITIES:
1. Foster and maintain provider relationship to facilitate current and future negotiations by
     * Performing claim research to provide support for desired savings;
     * Generating agreements by communicating with providers by written and verbal                   
        communication throughout the negotiation process; and
          a. Address counter-offers received and present proposal for resolution while adhering to                    client guidelines and department goals.
          b. Seek opportunities to achieve savings with previously challenging/unsuccessful providers
     * Partnering with internal and external clients, including Account Managers, Customer
        Relations, Provider Services, and direct client contacts as applicable.
2. Initiate provider telephone calls with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.
     * Up to 40% of time will be on phone with providers
3. Meet and maintain established departmental performance metrics.
4. Manage high volume of healthcare claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims.
     * Must be versatile to handle multiple clients with different requirements with different rules
     * Knowledge of Workers' Compensation or automobile medical ("auto") claims/bills is a plus:
5. Collaborate, coordinate, and communicate across disciplines and departments.
6. Ensure compliance with HIPAA protocol.
7. Demonstrate Company's Core Competencies and values held within.
8. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:
The individual in this position works under general supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the negotiation of health care claims/bills and provider agreements. Work is sometimes complex and requires some independent judgment within established guidelines. More complex issues are referred to higher levels. This job has regular contact with internal and external customers.

Job Requirements

 

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