LOP Negotiations Specialist

Job DescriptionJob DescriptionJob Summary:
The LOP/Negotiations Specialist is responsible for managing accounts that involve Letters of Protection (LOP) and negotiating settlements with attorneys and other payors to ensure optimal reimbursement for claims. This role involves regular communication with attorneys' offices, issuing records and affidavits, and tracking the progress of settlements, following company protocols. The LOP/Negotiations Specialist must exercise sound judgment and maintain compliance with company and legal standards to secure appropriate financial outcomes.

Supervisory Responsibilities:
None

Duties & Responsibilities:
• Coordinate with attorney offices to obtain Letters of Protection (LOP) for clients, ensuring all required documentation aligns with company guidelines.
• Issue and manage necessary records and affidavits to ensure proper documentation and validation for each LOP case.
• Update and maintain accurate records in the EHR for each LOP, including attorney contact information, case status, and any special conditions related to the protection letter.
• Track the progress of LOP cases from initial agreement to settlement, ensuring all steps are documented per billing SOP.
• Proactively monitor settlement timelines and communicate with attorneys to verify expected dates of case resolution.
• Ensure all actions are recorded in the billing software, including dates, communications, and any materials issued to attorneys.
• Review each case for appropriate reimbursement eligibility and evaluate the impact of settlements on the company's financial outcome.
• Negotiate settlements directly with attorneys and other payors to maximize reimbursement, assessing fair and reasonable rates based on case complexity and existing agreements.
• Engage in follow-up discussions to finalize and document any reimbursement agreements or settlement adjustments as needed.
• Analyze denied or underpaid LOP cases to determine whether appeal or reconsideration is viable, working within the company’s SOP and compliance guidelines.
• Review and update internal SOPs related to LOP cases as needed, incorporating the latest legal and billing standards for LOPs and settlements.
• Ensure all documentation sent to attorneys adheres to privacy regulations, confidentiality agreements, and legal requirements.
• Adheres directly to all communication guidelines per specific insurance payer requests.
• Work with Patient Care Advocate to enlist patients' assistance with claim.
• Communicate with patients and payers with the utmost respect and professionalism.
• Investigate insurance fraud and report to the Director of Billing, then the company board member, as necessary.
• Perform other duties as assigned.

Required Skills & Abilities:
• Excellent verbal and written communication skills.
• Proficient in Microsoft Office Suite and Adobe Acrobat Pro.
• Ability to operate related office equipment, such as computers, 10-key calculator, and copier.
• Ability to work independently and in a fast-paced environment.
• Ability to anticipate work needs and interact professionally with customers.
• Excellent organizational skills and attention to detail.

Education & Experience:
• High school diploma or equivalent required; Associate's or bachelor's degree preferred.
• At least three years of related experience required.

EEO/AA Employer/Vet/Disabled.

The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

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Company DescriptionFounder and CEO, Janice Bryant Howroyd, is a North Carolina native who left her hometown in 1976 armed with $1500. Since then, she has dedicated her efforts to building an organization that is committed to keeping the humanity in Human Resources and Strategic, Inclusive Procurement.

Mrs. Howroyd’s commitment to excellence has grown ActOne Group to 33 countries, with over 17,000 clients and more than 2,800 employees. The largest woman-minority-owned workforce management company founded in the US, ActOne Group professionals bring expertise in delivering corporate HR initiatives to local and global markets.

Mrs. Howroyd was selected by former President Barack Obama to serve as a White House appointee and continues to serve under the current administration as an Ambassador of Energy. Mrs. Howroyd gives generously through funding and advocacy for STEM education, particularly for women and minorities.

Mrs. Howroyd leads her teams to build business success based on the ability to connect great companies with outstanding talent. Her passion for education, mentorship, and self-empowerment initiatives have earned her many professional and philanthropic recognitions. She is a sought–after speaker and media subject matter expert in her fields. Her book, The Art of Work: How to Make Work, Work for You, is available on Amazon.com.Company DescriptionFounder and CEO, Janice Bryant Howroyd, is a North Carolina native who left her hometown in 1976 armed with $1500. Since then, she has dedicated her efforts to building an organization that is committed to keeping the humanity in Human Resources and Strategic, Inclusive Procurement.\r
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Mrs. Howroyd’s commitment to excellence has grown ActOne Group to 33 countries, with over 17,000 clients and more than 2,800 employees. The largest woman-minority-owned workforce management company founded in the US, ActOne Group professionals bring expertise in delivering corporate HR initiatives to local and global markets.\r
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Mrs. Howroyd was selected by former President Barack Obama to serve as a White House appointee and continues to serve under the current administration as an Ambassador of Energy. Mrs. Howroyd gives generously through funding and advocacy for STEM education, particularly for women and minorities.\r
\r
Mrs. Howroyd leads her teams to build business success based on the ability to connect great companies with outstanding talent. Her passion for education, mentorship, and self-empowerment initiatives have earned her many professional and philanthropic recognitions. She is a sought–after speaker and media subject matter expert in her fields. Her book, The Art of Work: How to Make Work, Work for You, is available on Amazon.com.

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