Contracts Specialist

Contracts Specialist

JOB SUMMARY:

This role is responsible for handling pre-claim and OON physician contract negotiations for all clients coupled with reaching out to senior management at facilities across the country to secure lowest settlement rate.

DUTIES:

1. Handles facility, provider and client inquiries regarding pre-claims and OON physician contract requests; including correspondence.

2. Secures signed agreements for reimbursement with providers.

3. Research claims to confirm our history with the provider

4. Determines cost saving opportunities and pricing optimization strategies.

5. Contact providers to discuss pricing in order to ensure patients can have services rendered.

6. Maintains relationships with central providers.

7. Ensures clear documentation of events associated with a claim resolution.

8. Provides updates and solicits required information from clients as needed.

9. Keeps direct report informed of critical matters that impact responding timely to pre-claim or physician contract requests.

10. Manages a daily running inventory of claims, prioritizing one's work schedule accordingly.

11. Addresses emails and incoming calls.

12. Collaborates, coordinates, and communicates across disciplines and departments.

13. Ensures compliance with HIPAA regulations and requirements.

14. Demonstrates Company's Core Competencies and values held within.

15. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High-Risk Role.

16. 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:

This position works independently under minimal supervision to complete the assigned job responsibilities. Work performed is often varied and complex, requiring a reliance on a knowledge base built through experience. The incumbent follows established procedures and uses knowledge of the company's general business principles, industry dynamics, market trends, and specific operation details when performing the duties of the position as assigned.

REQUIREMENTS:

* Minimum high school diploma plus two (2) years' experience in a medical healthcare claims role dealing with facilities, providers and members.
* Background in healthcare claims management environment including provider hospital billing, claims adjudication and administration or the ability to interpret benefit plans/Explanation of Benefits
* Demonstrated negotiation experience
* A proactive, self-starter
* A high level of professionalism, organization and flexibility
* Strong organizational skills, demonstrating strong attention to detail
* Strong communication skills, both oral and written
* Excellent organizational skills demonstrating strong attention to detail
* Ability to manage high call volume
* Ability to multi-task effectively
* Detail focused
* Self-Motivating personality and a professional demeanor that promotes a team environment.
* Manages self and time so as to meet provided timeframes and deadlines, becoming flexible when necessary
* Able to work comfortably in a fast-paced environment
* Solid problem-solving skills with the ability to determine and take the appropriate course of action for resolution
* Should possess a moderate to high level of claim editing, coding, RVU and CMS-based pricing knowledge with an emphasis in researching solutions for the above items as needed
* Bilingual preferred
* PC literate, including Microsoft Office products and web-based applications
* Required licensures, professional certifications, and/or Board certifications as applicable
* 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
* Regular, timely attendance

COMPENSATION:

The salary range for this position is $25 to $31.25 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.

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Why Claritev?

Healthcare is complex. We help make it clearer.

At Claritev, you'll do work that matters. Together, we're helping make healthcare more transparent and affordable for all through the power of data, technology, and expertise. We offer meaningful opportunities to grow your career, collaborate with talented colleagues, and make an impact on the clients and communities we serve. If you're looking for purpose, growth, and a team that succeeds together, you'll find it here.

What Guides Us

At Claritev, innovation, agility, and a focus on results drive our success. We embrace bold thinking, work as one team, take ownership, and strive for excellence in everything we do - creating meaningful impact for our clients, communities, and each other.