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Claims Resolution Specialist
Naperville, IL
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 talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!
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
* 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.
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.
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.
The salary for this position starts at $19.31. 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.
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, 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. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
Open
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