Senior Medical Claims Resolution Specialist

JOB SUMMARY:This position is responsible for negotiating certain type and dollar size of assigned claims/bills that are more complex on behalf of the payor to achieve maximum discount and savings. In addition, this job may also be responsible for coaching and mentoring. JOB ROLE AND RESPONSIBILITIES: 1. Foster and maintain provider relationship to facilitate current and future negotiations by * Performing claim research and analysis to provide support for desired savings.* Generating agreement by communicating with provider by written and verbal communication throughout the negotiation process; and * Partnering with internal and external clients, including Account Managers, Customer Relations, Provider Services, and direct client contacts as applicable.2.Meet and maintain established departmental performance metrics. Manage high volume of claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims.3. Initiate provider telephone calls with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.4. Address counteroffers received and present proposal for resolution while adhering to client guidelines and department goals.5.Identify and seek opportunities to achieve savings with previously challenging/unsuccessful providers.6. Participate in projects and initiatives, as necessary.7. Collaborate, coordinate, and communicate across disciplines and departments.8. Ensure compliance with HIPAA protocol.9. Demonstrate Company Core Competencies and values held within.10. Please note due to the exposure of PHI sensitive data — this role is considered to be a High Risk Role.11. 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 incumbent works under limited supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the negotiation of provider agreements. Work is more complex and requires independent judgment within established guidelines. This job has regular contact with internal and external customers, as well as medical review staff. While this is not a supervisory position, an incumbent acts as a resource to other team members and management.Qualifications JOB REQUIREMENTS: (Education, Experience, and Training) * Minimum high school diploma or GED* Minimum Bachelor’s degree (B.A.) in related field preferred * Minimum 3 years of experience in the health care or medical insurance industry (clinical, provider billing, provider collections, insurance, or managed care), or 1 year experience as a Claims Resolution Specialist * 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 commonly used medical data resources.* Knowledge of general office operations and/or experience with standard medical insurance claim forms* Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers’Compensation or automobile medical (“auto”) bills* Communication (verbal, written and listening), teamwork, negotiation, and organizational skills.* Ability to use clinical and coding based knowledge to negotiate applicable claims.* Ability to provide attention to detail to ensure accuracy including mathematical calculations.* Ability to commit to providing a level of customer service within established standards.* Ability to organize workload to meet deadlines and participate in department/team meetings.* Ability to analyze data and arrive at a logical conclusion.* Ability to identify issues and determine appropriate course of action for resolution.* Ability to display professionalism by having a positive demeanor, proper telephone etiquette and using proper language and tone.* Ability to elicit trust and credibility with all levels of the organization.* Ability to use software and hardware related to job responsibilities, including MS Office Suite and database software.* Ability to work with accuracy in a fast-paced environment.* Ability to adjust/alter workflow to meet deadlines.* Ability to work independently and handle confidential information.* Ability to process detailed verbal and written instructions.* Ability to mentor less experienced team members.* 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.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.