Negotiations Specialist - Remote

NEGOTIATIONS SPECIALIST - ALLIANCE HEALTH SYSTEM

Role

The Revenue Cycle Management Negotiations Specialist plays a crucial role in the clinical back-office setting, ensuring effective and timely collection of outstanding payments from patients, insurance companies, and other third-party payers. The Negotiations Specialist manages the revenue cycle process, maximizes revenue realization, and contributes to the financial stability of the organization.

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

- High school diploma or equivalent. 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.

- 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.

- 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.

-Ability to work independently, manage multiple priorities, and meet deadlines in a fast-paced clinical back office environment.

Background Check Requirement: Employment is contingent upon the successful completion of a background check, which may include verification of employment history, education, criminal records, and other relevant information as permitted by law