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Position Summary:

The Healthcare Claims Negotiator will build and maintain outstanding relationships with providers and while adhering to client’s policies and regulations, maximize savings amount for client.

Essential Functions:

Contact medical providers to negotiate greatest discount/savings on out of network claims submitted to Zelis
Contract with medical providers by utilizing out of network claim on hand as well as cold calling providers, Individual Physician Association (IPA’s), billing companies in order to generate bulk contracting opportunities
Monitor In-Process Claims Report in order to meet each client’s expected turnaround time
Assist providers on any related dispute/issue
Communicate with Client Service Associate on claim inquires as requested per provider
Work along other departments within the Zelis Enterprise including but not limited to the Claims Integrity Division
Maintain awareness of and ensure adherence to Zelis standards regarding privacy

Technical Skills/Knowledge:

Has a foundational proficiency in navigating claims and provider systems to achieve maximized savings for clients
Has a developing understanding of relevant technical aspects of claims negotiation, master contracts and usual/customary charges
Works on assignments that are complex in nature where judgment and initiative are required in resolving problems and making recommendations
Computer proficiency and technical aptitude with the ability to utilize proprietary system and MS Office applications
Independence/Accountability:

Requires minimal daily supervision
Receives detailed instructions on new assignments and determines next steps with guidance
Regularly reviews goals and objectives with supervisor
Ability to manage and prioritize multiple tasks
Ability to work under pressure and meet deadlines
Minimum Qualifications/Credentials (if any):

3+ years healthcare experience
Negotiation experience a plus
Excellent verbal communication skills
Exceptional organizational skills
Proficient knowledge of MS Office applications
Detail-oriented and able to work in a fast paced environment
Reference : Healthcare Claims Negotiator jobs

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Published at 26-10-2022
Viewed: 103 times