Member Advocate - Negotiator

Christian Care Ministry•Orlando, FL

11d•$66,500 - $90,500•Onsite

About The Position

The Member Advocate Negotiator works in close partnership with the Member Bill Advocate to resolve balance bills by engaging and negotiating directly with the provider or facility that issued the bill to the member. The Negotiator applies knowledge of Medicare reimbursement rates, market benchmarks, payer-provider fee schedules to anchor and advance negotiations toward a settlement that protects the member from unexpected out-of-network charges. The role owns the full negotiation lifecycle from case assignment through settlement execution and case closure. At lower activation scenarios, the Negotiator’s significant spare capacity supports provider contracting and network analytics.

Requirements

Advanced understanding of Program Guidelines to all member/provider issues
Strong written and verbal communication skill – able to explain settlement positions clearly to providers, members, and internal stakeholders
Disciplined documentation habits and proficiency with case management systems
Proficiency with CPT/ICD coding and Medicare fee schedule analysis
Understanding of managed care contracts
Negotiation skill – able to negotiate directly with hospital, facilities, and physician group medical billing office personnel at all levels
Ability to read, interpret and apply vendor and provider contracts
Knowledge and skill applying applicable state balance billing laws with the organizations policies, guidelines, and practices
Ability to apply common sense understanding to carry out instruction furnished in written, oral or diagram form; deal with problems involving several variables in standardized situations
Understanding of multi-band or multi-tier provider network program structures and delegated payment-integrity operations
Proficiency with Microsoft Office Suite (Excel, Word, Outlook, Teams, PowerPoint)
Bachelor’s degree in healthcare administration, Business, or Finance, required; combination of education or equivalent experience may satisfy this requirement
3+ years of experience in healthcare payment negotiation, provider contracting, or provider relations, required
Demonstrated experience negotiating directly with hospitals, facilities, or physicians’ groups required
Minimum Age Requirement: 18 years of age

Nice To Haves

Experiencing operating within or alongside a delegated payment-integrity / provider dispute vendor relationship a strong plus
Familiarity with healthcare sharing models and shared-eligibility determinations a plus
Prior experience handling third-part arbitration filings and working with managed care contracts preferred

Responsibilities

Receive balance-bill cases from the Member Advocate following intake, eligibility verification, and pathway determination; review the case file for completeness before initiating negotiation
Coordinate with the assigned Member Advocate on member context, prior provider communications, and any sensitivities that should shape negotiation tone or approach
Provide settlement updates and projected closure timeline to the Member Advocate on a defined cadence so the Advocate can keep the member informed within SLA windows
Hand back to the Member Advocate at settlement for member confirmation, CSAT capture, and case closure in the case management system
Research Medicare, market benchmarks, and applicable fee schedules to develop negotiation strategy and opening offers for each case
Review provider claims for CPT/ICD coding accuracy, and billing reasonableness prior to negotiation; flag suspected coding errors or upcoding for Paralegal review when warranted
Prepare a documented negotiation plan for each case identifying opening offer, target range, walk-away threshold, and supporting evidence
Conduct direct payment negotiations with the provider or facility that issued the balance bill to the member, on the member’s behalf
Manage the full negotiation lifecycle: provider outreach, counter-offer cycles, settlement execution, and case closure
Operate within Negotiator-defined settlement authority thresholds; obtain Advocacy Team Manager authorization for settlement parameters that exceed those thresholds
Where the case has been routed through delegation, partner with the delegated team or assume internal handling per the established hand-off criteria; ensure no duplicative provider outreach
Document all negotiation activity, communications, and settlement terms in the case management system in real time and to audit-ready standards
Maintain accurate, current case status so that the Member Advocate, Manager, and any delegated vendor can rely on a single source of truth for the case
Collaborate with paralegals on legal case file preparation for complex, high-dollar, or multi-party negotiations
Escalate unresolvable cases to the Advocacy Team Manager and coordinate transition to alternative dispute resolution, third-party arbitration, or external legal counsel as authorized
Coordinate with Claims, Network Management, or Provider Relations when a negotiation reveals a contracting, configuration, or claim-processing issue requiring upstream correction
Identify recurring provider billing patterns and report systemic issues to the Advocacy Team Manager for network-level correction
Maintain current knowledge of applicable state balance billing law and the organization’s sharing program guidelines as they affect provider negotiation strategy
Contribute lessons learned and successful negotiation tactics back to the team’s playbook and training materials
Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
All other duties as assigned

Benefits

100% paid Medical for employees/99% for family
Generous employer Health Savings Account (HSA) contributions
Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
6 weeks of paid parental leave (for both mom and dad)
Dental - two plans to choose from
Vision
Short-term Disability
Accident, Critical Illness, Hospital Indemnity
401(k) – up to 4% match on ROTH or Traditional contributions
Generous paid-time off and 11 paid holidays
Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
Employee Assistance Program including no cost, in-person mental health visits and employee discounts
Monetary Anniversary Awards Program
Monetary Birthday Awards
Tuition Reimbursement Program