Medical Claims Resolution Specialist

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 talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

The salary range for this position is $19.31- $20.32 an hour. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity



This position is responsible for contacting healthcare providers to discuss negotiations for a specific dollar range of eligible claims/bills prior to payment, in order to achieve maximum discounts and savings on behalf of payor/client



JOB ROLES AND RESPONSIBILITIES:



1. Manage a high volume of healthcare claims thoroughly to maximize savings opportunities on each claim within the established department production standards and individual goals by contacting provider on all assigned claims and presenting a proposal while maintaining high quality standards

• Perform provider research to provide support for desired savings


• Address counter-offers received and present proposal for resolution while adhering to client guidelines and policy and procedures


• Seek opportunities to achieve savings with previously challenging/unsuccessful providers


• Seek opportunities to establish ongoing global or concurrent agreements for future claims


• Update provider data base for reference and claims processing on subsequent claims

2. Initiate provider telephone calls as often required 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


• Provider education to providers online provider portal services available for proposal review and approval

3. Meet and maintain established departmental performance metrics

4. Handle post claim closure service inquires, including payment status and defending original negotiation terms

5. May require ACD phone responsibilities and tracking outcomes

6. Collaborate, coordinate, and communicate across disciplines and departments

7. Ensure compliance with HIPAA protocol.

8. Demonstrate Company's Core Competencies and values held within

9. Please note due to the exposure of PHI sensitive data - this role is considered to be a High Risk Role

10. 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 adheres to company policies and customer specific procedures to meet control standards. The Individual relies on established instructions and procedures, applies basic skills and may develop advanced skills using tools and equipment appropriate for the position. Duties and tasks are standardized and generally contain written instructions, allowing an individual to resolve routine questions and problems, and referring more complex issues to a higher level. Work is subject to defined work output standards and production which involves high volume claims resolution. Work involves direct contact with internal and external customers







JOB REQUIREMENTS (Education, Experience, and Training):

• Minimum high school diploma or GED along with six (6) months experience within the healthcare industry (provider billing, medical coding, provider collections, insurance or managed care); a full year of experience is high preferable.


• Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers' Compensation or automobile medical ("auto") bills a plus


• Knowledge of general office operations and/or experience with standard medical insurance claim forms


• Good Communication (verbal, written and listening) teamwork, negotiation and organizational skills

o Ability to process verbal and written instructions

o Display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone in a business professional environment.

• Ability to:

o Commit to providing a level of customer service within established standards

o Provide attention to detail to ensure accuracy including mathematical calculations

o Identify issues and determine appropriate course of action for resolution

o Organize workload to meet deadlines and participate in department/team meetings

o Adjust/alter workflow to meet deadlines in a fast-paced environment

o Work independently and handle confidential information

• Ability to use software and hardware related to job responsibilities, including MS Word and MS Excel spreadsheets and database software


• Required licensures, professional certifications, and/or Board certifications as applicable


• 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

BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

• Medical, dental, and vision coverage (low copay & deductible)


• Life insurance


• Short- and long-term disability


• 401(k) + match


• Generous Paid Time Off


• Paid company holidays


• Tuition reimbursement


• Flexible Spending Account


• Employee Assistance Program


• Summer Hours – we get off two hours early with pay every Friday beginning Memorial Day to Labor Day company-wide!


• Winter Hours- we get off early two hours with pay every third Friday with pay company-wide!

EEO STATEMENT

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.