Summary of Position:
The Medical Bill Negotiator role establishes contact with providers to negotiate savings on medical bills or pre or post service date. Working with the the Bill Review analysis team, Negotiator will apply proper jurisdictional regulations, reductions etc to the bill to establish a baseline from which negotiations will be calculated. Negotiator will contact the providers using any available means (phone, fax, email etc) in order to negotiate savings below the established baseline using proprietary metrics, historical results and other strategies as needed. The Negotiator then completes the appropriate reimbursement agreement and documents savings for clients.
Duties and Responsibilities:
- Determines cost saving opportunities and pricing optimization strategies.
- Reviews and analyzes EORs (Explanation of Reimbursement), medical bills and medical records.
- Completes negotiation tasks timely with respect to Client deadlines, Jurisdictional Due Dates.
- Enables a positive, effective relationship with the provider through phone calls and email communication while meeting client expectations.
- Obtains signed agreements from providers and document savings on medical bills.
- Maintains updated provider demographics, negotiation progress notes and successful outcomes in Open Claims log.
- Responds to customer questions regarding treatment and billing.
- Participates in planning, weekly meetings, and backlog sessions.
- Performs other duties as assigned by supervisors and managers.
- Complies with all company guidelines, code of conduct, policies, and standards.
Position Requirements:
- Current RN, BSN, CPC Certification a must
- Minimum 3 years nursing experience.
- Strong working knowledge of Microsoft Office 365 and Excel
- Strong communication skills, including the ability to respond to others professionally and in a timely manner.
- Must be able to work independently and possess the ability to develop and maintain constructive and cooperative working relationships.
- Strong attention to detail, with a high level of accuracy, and problem-solving skills.
- Requires strong organizational skills with proven capacity to handle multiple priorities.
- Be detail oriented with a high level of accuracy.
- Requires high level of skill in verbal and written communication, customer service, and effective telephone communication.
Other Duties:
As assigned: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.