Provider Contracting

1 week ago

Tampa, United States Leading Edge Administrators Full time
Job Summary:
The Provider Contracting and Negotiating Specialist I is responsible for working on behalf of the client to negotiate certain types of healthcare claims. This role will work directly with benefits providers to reach consensus and execute a single case agreement/fee or direct contract for submitted medical claims.

Duties and Responsibilities

• Initiate contact with provider offices for out of network services working from a queue

• Negotiate fees and rates with providers, facilities and others

• Perform data entry and documentation of repricing of medical claims

• Correspond with providers through all means (examples: phone, email, fax) and record contact and progress

• Oversee process to ensure claim is adjudicated

• Process out of network claims

• Keep communications current to provide responses and support within the assigned turn-around time

• Liaise directly with clients and other departments on negotiation requests

Requirements

Required Knowledge, Skills and Abilities:
  • HS Diploma or equivalent
  • 1 year of provider contracting, data or network administration experience preferably in a healthcare third party administrator setting or 2 years of claims processing or customer service experience in a medical/healthcare setting including knowledge of medical terminology
  • Prior work in production environment
  • Demonstrated ability in using a computer which includes expert keyboard and navigation skills and learning new programs
  • Solid working knowledge of standard computer applications including MS Word, Excel Outlook and PowerPoint
  • Ability to use a computer which includes expert keyboard navigation, web browsing and learning new programs
  • Communicate clearly and professionally with internal and external customers
  • Work effectively as part of a team to achieve established outcomes. Understand other's roles and empower one another to take responsibility to be successful.
  • Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
  • Pay close attention to detail in all aspects of the job
  • Make decisions using available resources and sound judgment
  • Maintain confidentiality and discretion
  • Identify and resolve problems in a timely manner, gather and analyzes information skillfully
  • Open to other's ideas and exhibits a willingness to try new things
  • Demonstrate accuracy and thoroughness; monitor work to ensure quality
  • Prioritize and plan work activities to use time efficiently
  • Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events
  • Act in such a way to instill trust from management, other associates, as well as customers
  • Work overtime as required
Physical Demands - The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.
  • Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
  • Constant: Specific vision abilities required by this job include close vision requirements due to computer work for full shift
  • Occasional: Lift and/or move up to 10 pounds
  • Constant: Regular, predictable attendance is required
  • Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
Work Environment - The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.
  • The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.


The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.

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