Balance Billing Coordinator II

Responsibilities

• Aid and educate 1199SEIU members and providers about contracts and benefits within the Funds network.
• Negotiate and resolve complex, high-dollar balance billing inquiries, fees, and discounts for members with non-participating providers through phone and written correspondence.
• Maintain ongoing communication with providers, members, attorneys, or collection agencies to resolve balance billing/fee negotiation issues.
• Proactively negotiate claims impacted by the No Surprises Act (NSA), aiming to resolve disputes with out-of-network providers before escalation to Independent Dispute Resolution (IDR).
• Utilize various databases to assess and compute reasonable rates, negotiating claim payments with providers, attorneys, and collection agencies on behalf of members.
• Affirmatively develop and maintain reporting structures for NSA claims, tracking metrics like settlement rates, cases escalated to IDR, and overall compliance with NSA guidelines.
• Generate and present detailed reports on NSA-related claim outcomes, including successful negotiations, escalated cases, and resolution timelines.
• Contribute to the development, maintenance, and monitoring of tracking databases to enhance Balance Billing Department functions and streamline workflow efficiency.
• Aid in training new and existing staff on balance billing and fee negotiation procedures to meet department performance standards.
• Collaborate with the Manager of Balance Billing Fee Negotiation to track, report, and achieve departmental goals.
• Identify and communicate barriers to achieving departmental objectives to management.
• Support management in coordinating and executing Balance Billing Department workflow initiatives and projects.
• Prepare and present daily, weekly, and monthly tracking reports to management, highlighting key trends and outcomes.
• Perform special projects and other duties as assigned by management.

Qualifications

• Associate’s degree or equivalent years of experience in hospital and medical claims processing.
• Minimum three (3) years of hospital and medical claims processing experience and minimum two (2) years of negotiation experience required.
• Comprehensive knowledge of NSA regulations, including experience navigating surprise billing protections, IDR processes, and QPA.
• Excellent critical thinking, attention to detail, and problem-solving skills; ability to work independently and as part of a team.
• Analytical and organizational skills with the ability to multitask and meet operational deadlines.
• Strong math skills and the ability to translate mathematical information into concise reports.
• Proficiency in conducting various data comparison analyses, working knowledge of macros, tables, forms, queries, and reports.
• Proficiency in Microsoft Office (Word, Excel, Access, Outlook).
• Ability to adapt to new software systems.
• Ability to work well under pressure, maintain professionalism, and present effectively.