Negotiator Analyst / Cost Containment SpecialistPrimary Location: Plymouth, MN
Additional Locations: AZ-Phoenix, CT-Hartford, FL-Tampa, IN-Evansville, MN-Plymouth, ND-Bismarck, NY-Amherst Apply
- Reviews inpatient, outpatient and professional claims/bills with pre-established dollar thresholds to determine negotiation strategy and potential savings.
- Capability to work in a production environment reviewing and negotiating 25-40 incoming claims/bills per day, on a daily basis.
- Utilizes manager and experienced negotiators to develop dialogue, persuasive delivery, and approach to ensure successful negotiations.
- Organizes and prioritizes incoming claims/bills to ensure client criteria are maintained (example: turnaround time) and established internal goals are met.
- Works with all departments to obtain information such as plan benefits and insured liability, to assist in the negotiation process.
- Handles phone and written inquiries from providers related to pre and post negotiations.
- Investigates and resolves issues surrounding pre and post negotiated claims/bills.
- Reviews provider and claim history to assist in determining appropriate percentage reduction for negotiation.
- Contacts provider via phone and fax as set forth under the established guidelines for claims/bills negotiations.
- Acquires a working knowledge of all lines of business including but not limited to Medical and Workers' Compensation.
- Strives to develop and maintain provider relationships.
- Documents system with information pertinent to claim/bill and provider.
- Reviews claims/bills to initiate Long Term Agreements and Master Contracts.
- Maintains and utilizes all resource material and systems to effectively manage job responsibilities.
- Independently reviews and determines resolution for claim/bill issues and concerns.
- Experience in a production environment.
- Medical Claims (examine, audit, process, etc) is REQUIRED
- Claim Editing Skills is REQUIRED
- Experience Benchmarking / able establish a reasonable rate & medical cost is REQUIRED
- CPC Certification preferred
- Licensure as required by state.
- Must have “Medical Claims” experience, which could be claims examiner, auditor, coding of claims to submit to payers, doing system edits for a claim platform, and with “coding experience” preferred (2-5 years)
- Should have both oral (telephone) and written aptitude which demonstrates accurate and effective communication and management of complex information (customer service, provider service, hospital billing, etc)
- Exposure to, or experience with, contracting, negotiating, medical cost estimates (fee schedules), is desirable
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