Provider Negotiations Specialist - Not Remote

Description:

***NOT A REMOTE POSITION***

Provider Negotiations Specialist Summary of Duties

The Provider Negotiations Specialist focus on reviewing medical bills/documentation and negotiating cost effective single case prospective and retrospective agreements with out-of-network Providers (i.e. physicians, healthcare facilities, and ancillary providers).

• Work collaboratively with Prime Corrections on cases where medical bills for inmates are determined to need a Single Case Agreement (SCA) or to be negotiated
• Collaborate with Customer Relations on cases where medical bills for members are determined to need a Single Case Agreement (SCA) or to be negotiated
• Develop, coordinate, and complete analysis of medical bills and documentation to ensure timely review and preparation of single case payment arrangements
• Performs contract recruitment, negotiations, and renegotiations of assigned Core contract targets and any other special contract projects as assigned
• Establishes and maintains positive relationships with Providers and their Business Office Manager

Requirements:

• Bachelor's degree in business or a health-related field of study from an accredited college or university with
• > 2 years of work experience in healthcare, insurance, claims processing, and medical billing/pricing; Prior experience as a Case Manager or Utilization Review Manager is preferred
• Understand payment methodologies (i.e., APR DRG, MS DRG, APGs, APCs, RBRVS, Per Diems)
• Prior experience in managed care contracting/negotiations and claims resolution are preferred
• Demonstrated proficiency in Microsoft Office (Excel, PowerPoint, Word, MS Teams) is required

• Detailed focused and organized with effective time management / follow-up/follow through skills
• Ability to work in a fast paced, changing environment; flexible to meet business needs
• Results driven collaborator with a proven history of leading, mentoring, and training others
• Ability to maintain confidential information; excellent communication skills (oral and written)
• Superb critical thinking skills and the ability to persuade / influence others

• Medical Insurance (high deductible plan with an HSA)
• Dental Insurance
• Vision Insurance
• Short-term and long-term disability paid by the company
• Group term life paid by the company
• PTO - 160 hours (4 weeks) with the ability to roll over 40 hours and cash out 40 hours at the end of the year
• Fitbit program with monetary rewards
• Employee recognition programs with monetary rewards
• Corporate office amenities - specialty coffee machines, assorted tea options, smoothie bar, collaborative workspaces, fruit provide by company and an onsite market
• Regular employee events such as potlucks, video game tournaments, door decorating contests, Mental Health Awareness Month activities, and a company carnival just to name a few of our past events

About Us

Since 2001, we have specialized in medical provider network development and offer clients a tailored approach to medical cost containment: quality health care at discounted rates.

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