Contract Specialist

Claritev•New York, NY

3d•$25 - $31

About The Position

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential. Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!! 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.

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

Nice To Haves

Bilingual preferred

Responsibilities

Handles facility, provider and client inquiries regarding pre-claims and OON physician contract requests; including correspondence.
Secures signed agreements for reimbursement with providers.
Research claims to confirm our history with the provider
Determines cost saving opportunities and pricing optimization strategies.
Contact providers to discuss pricing in order to ensure patients can have services rendered.
Maintains relationships with central providers.
Ensures clear documentation of events associated with a claim resolution.
Provides updates and solicits required information from clients as needed.
Keeps direct report informed of critical matters that impact responding timely to pre-claim or physician contract requests.
Manages a daily running inventory of claims, prioritizing one's work schedule accordingly.
Addresses emails and incoming calls.
Collaborates, coordinates, and communicates across disciplines and departments.
Ensures compliance with HIPAA regulations and requirements.
Demonstrates Company's Core Competencies and values held within.
Please note due to the exposure of PHI sensitive data -- this role is considered to be a High-Risk Role.
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.

Benefits

Medical, dental and vision coverage with low deductible & copay
Life insurance
Short and long-term disability
Paid Parental Leave
401(k) + match
Employee Stock Purchase Plan
Generous Paid Time Off – accrued based on years of service
10 paid company holidays
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits