Negotiations and Repricing Specialist

2 weeks ago

Atlanta, United States NANA Healthcare Management, LLC Full time
Job DescriptionJob DescriptionMount Yonah Medical Billing
Negotiations and Repricing Specialist
Job Description:
The Negotiations and Repricing Specialist is a vital member of the MYMB Care component of the System of Care. The Negotiations and Repricing Specialist is under the supervision of the Revenue Cycle Manager. The Negotiations and Repricing Specialist is responsible for collections of outstanding account receivable dollars from the existing client base and all other aspects of collections, resolving customer billing problems and reducing account receivables.

Type: Full time
Pay Rate: $17/HR
Schedule: Monday – Friday; 8:30am – 5pm
Education:
  • High School Diploma/GED AA degree preferred. 
  • Current (five-years) of no felonies or substance abuse convictions.
Experience:
  • Must have two-years of continuous sobriety prior to hire, if a recovering alcoholic or drug addict and participate in a self-help program.
  • 2 year of collections experience in the healthcare field preferred; preferably in the mental health and substance abuse field.
  • Knowledge of insurance submittals procedures and medical forms and coding. 

Knowledge and Training Required at Time of Hire:
  • Strong problem solving, follow through, and analytical skills required.
  • Excellent English; verbal and written communication skills required.
  • Ability to work independently and to adapt to a fast-changing environment.
  • Proficiency in Microsoft Office including Excel, Word and other medical collections software.
  • Must have attention to detail with an eye for accuracy.
  • Creative, self-disciplined and capable of identifying and completing critical tasks independently and with a sense of urgency required.
  • Must be able to speak clearly and concisely over the telephone.
Responsibilities:
  • Thorough Identification and resolution of problematic claims issues.
  • Resubmission of claims to insurance payers for payment and/or adjustment.
  • Review of accounts based on insurance payer and services provided to patients to determine accurate contractual payment amounts.
  • Resolve client-billing problems and rescue accounts receivable delinquency, applying good customer service in a timely manner.
  • Review EOB’s for language confirming the option to negotiate reimbursement.
  • Work with third parties to negotiate reimbursement for out-of-network services rendered.
  • Formulates recommendations and assists with implementation of changes to claims and appeals.
  • Generate appeals and call insurance companies to negotiate payment of outstanding claims.
  • Maintain records of claim changes and documentation justifying the claim.
  • Understand insurance carrier guidelines and stay abreast of any changes that occur in order to communicate them to management and staff.
  • Review and monitor assigned accounts and all applicable collection reports.
  • Provide timely follow-up on payment arrangements.
  • Mail correspondence to customers to encourage payment of delinquent accounts.
  • Fax documents to client accounts for effective follow up.
  • Performs other duties assigned.
Why You Should Join Our Team:
  • Paid training
  • Health insurance offered after 90 days
  • Accrued PTO offered after 90 days
  • Dental, vision, life insurance offered after 90 days
  • Opportunity to grow into a leadership role
  • Bonus structure after 90 days

 

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