Claims Resolution Specialist

Claims Resolution Specialist At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! JOB SUMMARY This position is responsible for contacting healthcare providers to discuss negotiations for a specific dollar range of eligible claims/bills prior to payment, in order to achieve maximum discounts and savings on behalf of payor/client. DUTIES 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. * Perform provider research to provide support for desired savings. * Address counteroffers received and present proposal for resolution while adhering to client guidelines and policy and procedures. * Seek opportunities to achieve savings with previously challenging/unsuccessful providers. * Seek opportunities to establish ongoing global or concurrent agreements for future claims. * Update provider data base for reference and claims processing on subsequent claims. 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. * Up to 40% of time will be on phone with providers. * Provider education to providers online provider portal services available for proposal review and approval 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. COMPENSATION The salary range for this position is $20.23 per hour. 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. REQUIREMENTS * Minimum high school diploma or GED * Minimum 6 months experience in the health care industry (provider billing, medical coding, provider collections, insurance, or managed care); 1 year preferred. * State licensure certification, including NY Health and/or P&C State Adjustor license, may be required. If hired without certification, certification must be obtained, and maintained thereafter, within six months of notification. If the required state licensure certification(s) are not obtained or renewed within six months of notification, an employee may be moved to a position within a relevant job family that does not require certification/licensure, if and when such position is available. When an alternate position is unavailable, other employment actions may be implemented consistent with Claritev practice and policy. * Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers' Compensation or automobile medical ("auto") bills a plus * 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. 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. * Ability to use software and hardware related to job responsibilities, including MS Word and MS Excel spreadsheets and database software. * 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. BENEFITS 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 opportunities. Your benefits will include: Medical, dental and vision coverage with low deductible & copay Life insurance Short and long-term disability Paid Parental Leave 401(k) + match Employee Stock Purchase Plan Generous Paid Time Off – accrued based on years of service WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service 10 paid company holidays Tuition reimbursement Flexible Spending Account Employee Assistance Program Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits EEO STATEMENT Claritev 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 would like more information on your EEO rights under the law, please click here . APPLICATION DEADLINE We will generally accept applications for at least 5 calendar days from the posting date or as long as the job remains posted. #LI-BH1