Healthcare Claims Negotiator – Zelis – Remote

Zelis is a healthcare and financial technology growth company and market-leading provider of claims cost management and payments optimization solutions to price, pay and explain healthcare claims. Zelis delivers integrated network analytics, network solutions, payment integrity, electronic payments and claims communications for payers, healthcare providers and consumers in the medical, dental and workers’ compensation markets nationwide. Zelis is backed by Parthenon Capital Partners and Bain Capital.

Zelis requires proof of Covid-19 vaccination upon hire.

Primary Responsibilities:

The Healthcare Claims Negotiator will build and maintain outstanding relationships with providers and while adhering to client’s policies and regulations, maximize savings amount for client.

Essential Functions:

  • Contact medical providers to negotiate greatest discount/savings on out of network claims submitted to Zelis.
  • Contract with medical providers by utilizing out of network claim on hand as well as cold calling providers, Individual Physician Association (IPA’s), billing companies in order to generate bulk contracting opportunities.
  • Monitor In-Process Claims Report in order to meet each client’s expected turnaround time.
  • Assist providers on any related dispute/issue.
  • Communicate with Client Service Associate on claim inquires as requested per provider.
  • Work along other departments within the Zelis Enterprise including but not limited to the Claims Integrity Division.
  • Maintain awareness of and ensure adherence to Zelis standards regarding privacy.

Experience Required:

Technical Skills/Knowledge

  • Has a foundational proficiency in navigating claims and provider systems in order to achieve maximized savings for clients
  • Has a developing understanding of relevant technical aspects of claims negotiation, master contracts and usual/customary charges
  • Works on assignments that are complex in nature where judgment and initiative are required in resolving problems and making recommendations
  • Computer proficiency and technical aptitude with the ability to utilize proprietary system and MS Office applications
  • Thorough knowledge of company and departmental policies and procedures
  • Ability to learn and understand Additional tools and software provided to use in everyday negotiation process

Independence/Accountability

  • Requires minimal daily supervision
  • Receives detailed instructions on new assignments and determines next steps with guidance
  • Regularly reviews goals and objectives with supervisor
  • Demonstrates competence in relevant job responsibilities which allows for increasing level of independence
  • Must have professional manner and respect the confidentiality of administrative matters and files
  • Ability to manage and prioritize multiple tasks
  • Ability to work under pressure and meet deadlines

Problem Solving

  • Recognizes basic problems, gathers appropriate information and seeks the help of others in formulating a solution
  • Excellent organizational skills are required to prioritize responsibilities, thus completing work in a timely fashion
  • Outstanding ability to multiplex tasks as required
  • Excellent project management skills.
  • Attention to detail and concern for impact is essential

Leadership Activities

  • Regularly attends and participates in departmental meetings
  • May provide general guidance to lower level staff
  • Must be proactive to ensure proper follow up and completion of projects
  • Must maintain a professional demeanor in sensitive situations
  • Assists other departments as necessary

Communication Skills

  • Must work well with others
  • Effectively communicates with others by giving and receiving feedback
  • Communicates ideas and information clearly

Special Qualifications/Credentials (if any):

  • 3+ years experience with claims processing
  • Excellent verbal communication skills
  • Exceptional organizational skills
  • Proficient knowledge of MS Office applications
  • Detail-oriented and able to work in a fast paced environment

“We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.”

Source: Indeed.com
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