US Medical Claims Arbitrator
Company Description
The U.S. health sector is complex and dynamic - a vast and diverse network of entities that impacts the population and economy like no other industry. At USD$4.1 Trillion, healthcare spending represents nearly 18% of U.S. GDP. It is complex and inefficient. Health service buying, selling, and settlements have seen little change in the past decade despite clear changes in available information, technology, regulation, and market consolidation.
Plotkin Health is a subsidiary of MacroHealth Solutions USA and we have more than two decade of experience in settling medical provider claims. At Plotkin Health, we specialize in all facets of medical loss mitigation, equally serving providers of medical service, health insurers and re-insurers of Medical Travel Insurance, both US based and internationally. We seamlessly navigate the complex ecosystem of high-value medical provider claims settlement.
We are looking for an experienced US Claims Negotiator to join our Claims Settlement Team. You will be responsible for pro-actively building relationships with medical providers, following up with hospitals and health care providers to secure and process settlements relating to medical claims and payments.
At Plotkin Health, our success is directly related to our ability to work together as a team–and the contributions of innovative team members are what keep us at the forefront of our industry.
Job Description
Salary Range: $70,000-80,000/year
Responsibilities:
- Communicate with out-of-network providers to negotiate claim payment on behalf of assigned payors
- Monitor and follow-up until resolution is obtained
- Identify options and processes to achieve the highest level of discounts
- Provide Negotiation Agreement and Repricing to payor
- Identifies providers that should be forwarded for recruiting into the network
- Maintains tracking mechanism to ensure timely return of all claims
- Generates monthly Savings reports
- Scanning of digital documents to cases
- Other duties and special projects as assigned
Qualifications
- Knowledge of US Health and health insurance plans
- Has a demonstrated history of working with US based Hospitals and Physicians.
- Commitment to deliver superior quality customer service on the phone, over video calls and emails
- 2+ years of US healthcare experience
- Understands US Facility and Professional Fee Billing, CPT, DRG Codes
- Demonstrate in-depth knowledge of eligibility, insurance policies and reimbursement
- Excellent organization, project management and oral/written communications skills
- In-depth understanding of payor guidelines
- Working knowledge of Microsoft Windows, Outlook, Work, Excel
- Demonstrated ability to work in a fast-paced team environment
- Detail oriented with ability to handle multiple assignments promptly and effectively
- Ability to navigate through a computerized system and other relevant applications while interacting with representatives on the phone
- Extensive experience working with Microsoft Office and Custom Databases
- Empathy, flexibility and patience in speaking with challenging representatives
- Excellent discretion and judgment skills
- Excellent probing and problem solving skills
- Ability to absorb and apply new and changing information
Additional Qualifications (Preferred but not required)
- Education: Bachelor Degree (BA/BS)
- Billing/Coding Certification or equivalent business experience
- Patient collections or healthcare negotiation experience.
- Bilingual – fluent in both English and Spanish an asset
Additional Information
More about us
Plotkin Health is a highly collaborative work environment where each team member can rely on the skills, expertise, and support of one another across the company. We operate with an open-door policy and are wide open to new perspectives for improving our operations and fueling future growth with a diverse and engaged team.
We offer
- Remote-friendly work environment
- Flexible PTO with no annual upper cap
- Extended parental leave
- Equity awards
- Extended medical, dental, and vision plan for employees and dependents
- 401K contributions matching
How we protect team members' health and safety
At Plotkin Health, we recognize the impacts of the global pandemic have taken shape differently for each of us based on our role, our location, our family situations, and job transitions. Health, safety and wellbeing are top of mind for us in supporting safe office environments as well as engaging team members working from home.
Diversity, Equity, and Inclusion
We are committed to facilitating constructive team member engagement and promoting a respectful work environment. We design our company processes to surface necessary conversations, engage multiple voices, remove barriers, and recognize contributions made at every level. We actively promote practices to create lasting change and partner with organizations that align with our values.
This role requires legal authorization to work in US
Plotkin Health is an equal opportunity employer.
MacroHealth is an equal opportunity employer.