This position is"responsible for negotiating specified types and"dollar amount of assigned claims/bills that are more complex on behalf of the"client to achieve maximum discount and savings from Equian reimbursement"determination.

The incumbent works"under general supervision to complete job responsibilities in applying a"fundamental knowledge of principles, practices and procedures related to the"negotiation of provider agreements. Work"is more complex and requires independent judgment within established"guidelines. More complex issues are"referred to higher levels. Incumbent may"mentor less experienced team members.

This position is full-time (40 hours/week) Monday - Friday."Employees are required to have flexibility to work any of our 8 hour shift"schedules during our normal business hours of (8:00am - 5:00pm). It may be"necessary, given the business need, to work occasional overtime.

Primary Responsibilities:

• Foster and maintain provider relationships to"facilitate current and future negotiations.

• Perform claim research and analysis to"provide support for appropriate savings.

• Initiate provider telephone calls with"respect to proposals, overcome objections and apply effective telephone"negotiation skills to reach successful resolution on negotiated claims.

• Address counter-offers received and present"proposal for resolution while adhering to client guidelines and department"goals.

• Meet and maintain established departmental"performance metrics.

• Manage high volume of claims in a queue; keep"current with all claim actions and meet client deadlines and any state specific"deadlines for working and closing claims.

• Identify and seek opportunities to achieve"savings with previously challenging/unsuccessful providers.

• Collaborate, coordinate, and communicate"across internal departments (i.e. Bill Review and Appeals).

This is a challenging role that takes an ability to"thoroughly review, analyze and research complex health care claims in order to"identify discrepancies, verify pricing, confirm prior authorizations and"process them for payment. You'll need to be comfortable navigating across"various computer systems to locate critical information. Attention to detail is"critical to ensure accuracy, which will impact the timely processing of the"member's claim.

You'll be rewarded and recognized for your performance in"an environment that will challenge you and give you clear direction on what it"takes to succeed in your role as well as provide development for other roles"you may be interested in.