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Medical Claims Resolution Specialist II, Appeals

3 weeks ago

New York, New York, United States Claritev Full time


At MultiPlan, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all of our stakeholders -- internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and upward



JOB SUMMARY: This position is responsible for contacting health care providers to negotiate certain type and dollar size health care claims/bills. Objective is to achieve maximum discounts and savings on behalf of the payor/client.
 
JOB ROLE AND RESPONSIBILITIES:
1. Foster and maintain provider relationship to facilitate current and future negotiations by
* Performing claim research to provide support for desired savings.
* Generating agreements by communicating with providers by written and verbal communication throughout the negotiation process; and
  a. Address counteroffers received and present proposal for resolution while adhering to client guidelines and department goals.
  b. Seek opportunities to achieve savings with previously challenging/unsuccessful providers.
* Partnering with internal and external clients, including Account Managers, Customer Relations, Provider Services, and direct client contacts as applicable.
2. Initiate provider telephone calls 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.
3. Meet and maintain established departmental performance metrics.
4. Manage high volume of healthcare claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims.
* Must be versatile to handle multiple clients with different requirements with different rules.
* Knowledge of Workers' Compensation or automobile medical ("auto") claims/bills is a plus:
5. Collaborate, coordinate, and communicate across disciplines and departments.
6. Ensure compliance with HIPAA protocol.
7. Demonstrate Company's Core Competencies and values held within.
8. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
9. 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 in this position works under general supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the negotiation of health care claims/bills and provider agreements. Work is sometimes complex and requires some independent judgment within established guidelines. More complex issues are referred to higher levels. This job has regular contact with internal and external customers.

Qualifications JOB REQUIREMENTS: (Education, Experience, and Training)
 
* Minimum high school diploma or GED
* Minimum of 2 years of experience in a service based industry preferably in the healthcare or medical insurance field (clinical, provider billing, provider collections, insurance or managed care preferred), or minimum 1 year experience as an Associate Claims Resolution Specialist/CRSI preferred.
* State licensure certification, including NY Health and/or P&C State Adjustor license, may be required. If hired without certification, certification must be obtained, and maintained thereafter, within six months of notification. If the required state licensure certification(s) are not obtained or renewed within six months of notification, an employee may be moved to a position within a relevant job family that does not require certification/licensure, if and when such position is available. When an alternate position is unavailable, other employment actions may be implemented consistent with MultiPlan practice and policy.
* Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes) desired
* Knowledge of general office operations and/or experience with standard medical insurance claim forms
* Good Communication (verbal, written and listening), teamwork, negotiation, and organizational skills.
o Ability to process detailed verbal and written instructions.
o Display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone.
* Ability to:
o Commit to providing a level of customer service within established standards.
o Provide attention to detail to ensure accuracy including mathematical calculations.
o Organize workload to meet deadlines and participate in department/team meetings.
o Identify issues and determine appropriate course of action for resolution.
* Ability to:
o Work with accuracy in a fast-paced environment.
o Adjust/alter workflow to meet deadlines.
o Work independently and handle confidential information.
* Ability to use software and hardware related to job responsibilities, including MS Office Suite and database software.
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone.

COMPENSATION

The salary range for this position is [SALARY RANGE]. 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.

BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

  • Medical, dental and vision coverage with low deductible & copay
  • Life insurance
  • Short and long-term disability
  • 401(k) + match
  • Generous Paid Time Off
  • Paid company holidays
  • Paid Parental Leave
  • Tuition reimbursement
  • Flexible Spending Account
  • Employee Assistance Program
  • Summer Hours

EEO STATEMENT

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.