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Claritev · 1 day ago

Claims Resolution Specialist II

United States

Full-time

Remote

New Grad, Entry Level

$20.23/hr - $20.23/hr

0+ years exp

Claritev is a dynamic team of innovative professionals focused on transforming healthcare through technology and data. The Claims Resolution Specialist II is responsible for negotiating healthcare claims with providers to achieve maximum discounts and savings for clients.

BillingHealth CarePayments

Responsibilities

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

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

Meet and maintain established departmental performance metrics

Handle post claim closure service inquiries, including payment status and defending original negotiation terms

May require ACD phone responsibilities and tracking outcomes

Collaborate, coordinate, and communicate across disciplines and departments

Ensure compliance with HIPAA protocol

Demonstrate Company's Core Competencies and values held within

Qualification

Healthcare claims managementNegotiation skillsMedical codingProvider billingHIPAA complianceCustomer serviceProfessionalismSoftware proficiencyCommunication skillsOrganizational skillsAttention to detailTeamwork

Required

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)

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

Good Communication (verbal, written and listening) teamwork, negotiation, and organizational skills

Ability to process verbal and written instructions

Display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone in a business professional environment

Ability to commit to providing a level of customer service within established standards

Provide attention to detail to ensure accuracy including mathematical calculations

Identify issues and determine appropriate course of action for resolution

Organize workload to meet deadlines and participate in department/team meetings

Adjust/alter workflow to meet deadlines in a fast-paced environment

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

Preferred

1 year experience in the health care industry (provider billing, medical coding, provider collections, insurance, or managed care)

Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers' Compensation or automobile medical ('auto') bills

Knowledge of general office operations and/or experience with standard medical insurance claim forms

Benefits

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

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

Company

Claritev

Glassdoor3.8

Claritev is an independent and public healthcare technology, data and insights company making healthcare more transparent, fair and affordable for all.

Founded in 1980

Mclean, Virginia, USA

1001-5000 employees