Medical Claims Analyst/Negotiator

Salary: $23-25 per hour

OVERVIEW:

Rapidly growing healthcare technology company is looking for outgoing, energetic, and motivated individuals to join our team of Claim Analysts. If you possess these qualities and want to be part of a passionate team on a mission to drive change in healthcare, then Green Light could be a great fit for you. Ideal candidates will share our core values, be a team player, possess a strong work ethic, be a problem solver, have professional integrity and a sense of humor!

JOB SUMMARY:

The Claims Analyst position is responsible for collaborating with out-of-network healthcare providers (telephonically, in most cases) to finalize allowed amounts on out-of-network claims. Our health plan clients have implemented various controls to establish out-of-network allowances and to ensure that non-contracted providers are paid fairly according to market data, for services provided to their health plan members. The Claims Analyst role facilitates any exceptions for higher out-of-network allowances on behalf of the health plan, in cases where patient balance billing can be eliminated, while also ensuring that out-of-network allowances adhere to the overall provisions of the health plan.

RESPONSIBILITIES:

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  Foster and maintain relationships with the Provider community to facilitate current and future claim settlements with professionalism.
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  Verbally and accurately communicate the various out-of-network pricing methodologies used by our health plan clients for establishing allowances on out-of-network claims.
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  Generate settlement agreements based on written and verbal communication with the Provider, throughout the settlement process.
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  Work with internal stakeholders, such as Client Services, to coordinate the necessary flow of information required to successfully obtain settlement of out-of-network healthcare claims.
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  Meet and maintain individual and departmental performance metrics.
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  Manage high volume of claims in a queue; keep current with all claim actions and meet client deadlines for working and settling claims.
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  Initiate provider telephone calls with respect to settlement proposals, mediate objections and apply effective telephone communication skills to reach successful resolution on out-of-network claims.
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  Address any counter offers and present proposals for resolution while adhering to client guidelines and department goals.
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  Collaborate, coordinate, and communicate across the organization, as is necessary to obtain successful settlement of claims.
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  Ensure compliance with HIPAA protocol.

QUALIFICATIONS:

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  3-5 years customer service experience
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  High school diploma or equivalent
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  Excellent verbal and written skills
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  Ability to multi-task and thrive in fast paced work environment
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  Willingness to perform high volume of outbound calls to healthcare providers
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  General knowledge of healthcare claims processing and medical terminology
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  Healthcare billing and/or coding background is a PLUS