Negotiations Specialist

Summary of Responsibilities

• Manage the collections process for negotiated claims, following up on unpaid claims, invoices, and patient balances.
• Utilize revenue cycle management software and tools to track and prioritize collection activities, ensuring timely and accurate follow-up.
• Review and analyze unpaid claims and denials, identifying the root causes and taking appropriate actions for resolution.
• Contact patients, insurance companies, and other payers to discuss outstanding balances, resolve billing discrepancies, and negotiate payment arrangements.
• Maintain accurate and up-to-date records of collection efforts, communications, and payment arrangements in compliance with legal and organizational requirements.
• Collaborate with billing and coding teams to ensure accurate and timely submission of claims and invoices for reimbursement.
• Stay updated with insurance industry regulations, billing guidelines, and reimbursement policies to maximize collections and minimize denials.
• Provide support and assistance to patients in understanding their insurance coverage, explaining billing statements, and addressing their financial concerns.
• Work closely with the finance department to reconcile payments received, identify posting errors, and ensure accurate accounting of collections.
• Generate reports and provide regular updates on collection metrics, aging accounts, and potential revenue risks to the revenue cycle management team.

Requirements

• A high school diploma or equivalent.
• An associate's or bachelor's degree in healthcare administration or a related field is preferred.
• Proven work experience as a Collections Specialist in a healthcare or clinical back office setting, with a focus on revenue cycle management.
• In-depth knowledge of medical billing and coding processes, insurance claim submission, and reimbursement procedures.
• Familiarity with insurance industry regulations, billing guidelines, and compliance requirements, including HIPAA.
• Proficiency in using revenue cycle management software and tools to manage collections activities, track accounts, and generate reports.
• A strong understanding of healthcare reimbursement methodologies, including commercial insurance, Medicare, and Medicaid.
• Excellent communication and negotiation skills, with the ability to interact professionally and empathetically with patients, insurance companies, and other stakeholders.
• A detail-oriented mindset, with the ability to review and analyze complex billing statements, claims, and denials.
• Strong problem-solving skills, with the ability to identify billing discrepancies, resolve disputes, and find solutions to payment challenges.
• The ability to work independently, manage multiple priorities, and meet deadlines in a fast-paced clinical back-office environment.

Benefits

• 401(k) matching
• Medical, Dental & Vision
• Paid Time Off
• Sick Time
• Paid Holidays