Medical Claims Resolution Specialist (Remote)

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 solutions.

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!

Come show off your negotiation skills as a Medical Claims Specialist in our Fee Negotiations Department. This position is responsible for contacting health care providers or the respective biller to negotiate certain type and dollar size health care claims/bills. Objective is to achieve maximum discounts and savings on behalf of the payor/client. The ideal candidates will have experience in collections, sales, or high volume call center in the healthcare or medical insurance field (clinical, provider billing, or insurance preferred) with good understanding of billing/ medical terminology and patient benefits.

• We provide an excellent paid virtual 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 www.multiplan.com
• You will have a steady Monday through Friday 40 hour per week schedule between the hours of 7:00 am and 5:00 pm.
• Earn $19.83 per hour (pay rate is dependent on employee’s location) and have the opportunity to receive additional quarterly bonuses based on performance after completion of the 90 work days (training period).

JOB ROLES AND RESPONSIBILITIES:

1. Manage a high volume of healthcare claims thoroughly to maximize savings opportunities on each claim within the established department production standards and individual goals by contacting provider on all assigned claims and presenting a proposal while maintaining high quality standards.

• Seek opportunities to achieve savings with previously challenging/unsuccessful providers
• Update provider data base for reference and claims processing on subsequent claims
• Address counter-offers received and present proposal for resolution while adhering to client guidelines and policy and procedures
• Seek opportunities to establish ongoing global or concurrent agreements for future claims
• Perform provider research to provide support for desired savings

2. Initiate provider telephone calls as often required with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.

• Provider education to providers online provider portal services available for proposal review and approval
• Up to 40% of time will be on phone with providers

3. Meet and maintain established departmental performance metrics
4. Handle post claim closure service inquires, including payment status and defending original negotiation terms.
5. May require ACD phone responsibilities and tracking outcomes.
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. Please note due to the exposure of PHI sensitive data - this role is considered to be a High Risk Role.
10. 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.

JOB SCOPE:

The Individual adheres to company policies and customer specific procedures to meet control standards. The Individual 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 individual to resolve routine questions and problems, and referring more complex issues to a higher level. Work is subject to defined work output standards and production which involves high volume claims resolution. Work involves direct contact with internal and external customers.

JOB REQUIREMENTS (Education, Experience, and Training):

• Minimum high school diploma or GED along with six (6) months experience within the healthcare industry (provider billing, medical coding, provider collections, insurance or managed care); a full year of experience is high preferable.
• Knowledge of general office operations and/or experience with standard medical insurance claim forms
• Good Communication (verbal, written and listening) teamwork, negotiation and organizational skills
• Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers' Compensation or automobile medical ("auto") bills a plus

o Ability to process verbal and written instructions
o Display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone in a business professional environment.

• Ability to:

o Commit to providing a level of customer service within established standards
o Provide attention to detail to ensure accuracy including mathematical calculations
o Identify issues and determine appropriate course of action for resolution
o Organize workload to meet deadlines and participate in department/team meetings
o Adjust/alter workflow to meet deadlines in a fast-paced environment
o Work independently and handle confidential information

• 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
• Ability to use software and hardware related to job responsibilities, including MS Word and MS Excel spreadsheets and database software
• Required licensures, professional certifications, and/or Board certifications as applicable

BENEFITS

• Employee Assistance Program
• Paid company holidays
• Tuition reimbursement
• Summer Hours – we get off two hours early with pay every Friday beginning Memorial Day to Labor Day company-wide!
• Winter Hours- we get off early two hours with pay every third Friday with pay company-wide!
• Flexible Spending Account
• Life insurance
• 401(k) + match
• Generous Paid Time Off
• Medical, dental, and vision coverage (low copay & deductible)
• Short- and long-term disability

EEO STATEMENT

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 click here.

**Pursuant to Colorado’s “Equal Pay for Equal Work Act”, the following salary range is provided solely for applicants living in Colorado $19.83 - $20/hr. If an applicant does not live in Colorado, this salary range may not apply. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.