Medical Claims Specialist (Monday - Friday 9am-3pm)
Company: MultiPlan Inc.
Posted on: June 7, 2021
Imagine a workplace that encourages you to interpret, innovate
and inspire. Our employees do just that by helping healthcare
payers manage the cost of care, improve competitiveness and inspire
positive change. You can be part of an established company with a
40-year legacy that helps our customers thrive by interpreting our
client's needs and tailoring innovative healthcare cost management
Our commitment to diversity, inclusion and belonging are part of
the fabric of our company. We strive to create a workplace that
fosters mutual respect and collaboration, where every talent
individual can participate and perform their best work. We are
MultiPlan and we are where bright people come to shine!
As a Medical Claims Resolution Specialist::
- You will have a steady Monday through Friday 30 hour per week
schedule 9:00 am to 3:00 pm.
- Currently, this position is a remote or, work from home,
position but will be located in our Irving, TX office when it
- Earn $16.83 per hour and have the opportunity to receive
additional quarterly bonuses based on performance after completion
of the training period.
- We provide an excellent paid classroom training program as well
as continuous on the job coaching and mentoring. We also have
advancement and growth opportunities available to employees.
- Find more information on what it's like to be a MultiPlan
employee on our Careers page at [ Link Removed ]
JOB SUMMARY: This position is responsible for negotiating small
dollar claims including retrospective and concurrent claims on
behalf of payor to achieve maximum discount from bill amount prior
JOB ROLES AND RESPONSIBILITIES:
Maximize savings opportunities on each claim within the
established department and individual goals by contacting provider
on all assigned claims and presenting a proposal while maintaining
high quality standards.
Initiate provider telephone calls as often required with respect
to proposals and respond to providers following receipt of
proposal. Includes follow up phone calls on system automated
communications to providers.
Address counter-offers received and present proposal for
resolution while adhering to client guidelines and department
Provide education to providers on online services available for
proposal review and approval.
Process claims agreements in database and close out claims;
including updating provider data base for reference and claims
processing on subsequent claims.
Identify and seek opportunities to establish ongoing global or
concurrent agreements for future claims.
Identify and seek opportunities with previously challenging
providers to achieve savings.
Handle post claim closure inquires, including payment status and
defending original agreements terms.
May require ACD phone responsibilities and tracking
Collaborate, coordinate, and communicate across disciplines and
Ensure compliance with HIPAA regulations and requirements.
Demonstrate Company's Core Competencies and values held
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.
The incumbent adheres to company policies and customer specific
procedures to meet control standards. An incumbent relies on
established instructions and procedures, applies basic skills and
may develop advanced skills using tools and equipment appropriate
for the position. Duties and tasks are standardized and generally
contain written instructions, allowing an incumbent to resolve
routine questions and problems, and referring more complex issues
to a higher level. Work is subject to defined work output standards
and involves high volume claims resolution. Work involves direct
contact with internal and external customers.
- Minimum high school diploma or GED
- Minimum 6 months experience in the health care industry
(provider billing, provider collections, insurance or managed
care); 1 year preferred
- Required licensures, professional certifications, and/or Board
certifications as applicable
- Knowledge of medical coding desired
- Knowledge of applicable laws and statutes (state, local or
federal) for positions focusing on Workers' Compensation or
automobile medical ("auto") bills.
- Knowledge of commonly used medical data resources desired
- Knowledge of general office operations and/or experience with
standard medical insurance claim forms
- Communication (verbal, written and listening) and
- Negotiation skills preferred
- Ability to provide attention to detail to ensure accuracy
including mathematical calculations
- Ability to provide a level of customer service within
- 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
- Ability to use software and hardware related to job
responsibilities, including MS Word and MS Excel spreadsheets and
- Ability to adjust/alter workflow to meet deadlines in a
- Ability to work independently and handle confidential
- Ability to process 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
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
Your benefits will include:
- Medical, dental, and vision coverage (low copay &
- Life insurance
- Short- and long-term disability
- 401(k) + match
- Generous Paid Time Off
- Paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Summer Hours
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'd like more
information on your EEO rights under the law, please [ Link Removed
Keywords: MultiPlan Inc., Irving , Medical Claims Specialist (Monday - Friday 9am-3pm), Other , Irving, Texas
Didn't find what you're looking for? Search again!