IrvingRecruiter
the smart solution for Irving jobs

Medical Claims Resolution Specialist, II OON

Company: Multiplan
Location: Irving
Posted on: June 13, 2018

Job Description:

JOB SUMMARY:

This position is responsible for negotiating certain type and dollar size of assigned claims/bills with generally lower complexity on behalf of the payor to achieve maximum discount and savings.



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 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 counter-offers received and present proposal for resolution while adhering to client guidelines and department goals.

5. Seek opportunities to achieve savings with previously challenging/unsuccessful providers.

6. Collaborate, coordinate, and communicate across disciplines and departments.

7. Ensure compliance with HIPAA protocol.

8. Demonstrate Company's Core Competencies and values held within.

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.



Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.

JOB SCOPE:

The incumbent works under general supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the negotiation of 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.



* 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 license certification preferred

* Additional licensures, professional certifications, and/or Board certifications required as applicable

* Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes) desired

* Knowledge of commonly used medical data resources preferred.

* Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers' Compensation or automobile medical (\\"auto\\") bills:

* Knowledge of general office operations and/or experience with standard medical insurance claim forms

* Communication (verbal, written and listening), teamwork, negotiation and organizational skills

* Ability to commit to providing a level of customer service within established standards

* Ability to provide attention to detail to ensure accuracy including mathematical calculations

* 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 use of proper language and tone.

* 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

* 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.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Keywords: Multiplan, Irving, Medical Claims Resolution Specialist, II OON, Healthcare, Irving, Texas

Click here to apply!

Didn't find what you're looking for? Search again!


I'm looking for
in category
within


Other Healthcare Jobs


Physical Therapist (FT) - Grand Prairie - Dallas
Description: JOB TITLE: Pediatric Physical TherapistREPORTS TO: Divisional Manager FLSA STATUS: Exempt JOB OVERVIEW: The Pediatric Physical Therapist is a qualified, licensed professional who provides, evaluates and (more...)
Company: THERAPY 2000
Location: Dallas
Posted on: 06/23/2018

Registered Nurse RN Medical Telemetry Night Job
Description: Registered Nurse RN Medical Telemetry Night Job- DescriptionThe Medical Telemetry Registered Nurse RN exhibits and executes Baylor Scott White Health's BSWH Values Behaviors in delivering and (more...)
Company: Baylor Scott White Health
Location: Dallas
Posted on: 06/23/2018

RN Care Manager BSN (PRN) (Irving)
Description: RN Care Manager BSN PRN Irving - 18007629 br Description br The RN Care Manager serves as a Bachelor's level care manager with responsibility for assessing, coordinating patient care, evaluating (more...)
Company: Baylor Scott White Health
Location: Irving
Posted on: 06/25/2018


Occupational Therapist (OT) - Inpatient
Description: Job Description ul li Occupational Therapist OT - InpatientJob ID63632LocationUS-TX-GrapevineExperience Years 3CategoryTherapy - Occupational TherapistStreet Address1650 W College StCompanyBaylor (more...)
Company: Select Medical
Location: Grapevine
Posted on: 06/25/2018

Registered Nurse RN Clinical Decision Unit Day Job
Description: Registered Nurse RN Clinical Decision Unit Day Job- 18001259 br Description br The Clinical Decision Unit Registered Nurse RN exhibits and executes Baylor Scott White Health's BSWH Values (more...)
Company: Baylor Scott White Health
Location: Dallas
Posted on: 06/23/2018

Occupational Therapist (PT) - Garland
Description: JOB TITLE: Pediatric Occupational Therapist REPORTS TO: Divisional ManagerFLSA STATUS: Exempt JOB OVERVIEW: The Pediatric Occupational Therapist is a qualified, licensed professional who provides, evaluates (more...)
Company: THERAPY 2000
Location: Dallas
Posted on: 06/23/2018

Nurse Supervisor Operating Room
Description: Nurse Supervisor Operating Room- 18008896 br Description br The nursing supervisor is responsible for supervision of all nursing and unit-based personnel on designated shift and the provision of (more...)
Company: Baylor Scott White Health
Location: Plano
Posted on: 06/25/2018

Interventional Radiology RN - FT Days
Description: Interventional Radiology RN - FT Days- 18007399 br Description br The Registered Nurse RN exhibits and executes Baylor Scott White Health's BSWH Values Behaviors in delivering and coordinating (more...)
Company: Baylor Scott White Health
Location: Irving
Posted on: 06/23/2018

Occupational Therapist - Outpatient
Description: Job Description ul li Occupational Therapist - OutpatientJob ID73976LocationUS-TX-GarlandExperience Years 3CategoryTherapy - Occupational TherapistStreet Address705 Walter Reed Drive, Suite 100CompanyBaylor (more...)
Company: Select Medical
Location: Garland
Posted on: 06/25/2018

Remote Medical Coder with Multi-Specialties
Description: Coding Denials, ER, OBGYN, Surgical, E/M, Neurology, Neurosurgery, Oncology, Hematology, Orthopedic Pathology Multi-specialties We are
Company: Mommy Jobs Online
Location: Mesquite
Posted on: 06/23/2018

Log In or Create An Account

Username:
Password:
 

Forgot password?


Find us on Facebook

Find us on LinkedIn

Get the latest Texas jobs by following @recnetTX on Twitter!

Irving RSS job feeds