We are currently seeking a Medical Bill Negotiation Specialist /Healthcare Advocate.  The Individual will be responsible for negotiating medical procedure prices and medical bills directly with providers on behalf of our members and have a key role in our healthcare advocate department. 

Duties and Responsibilities

• Independently review and analyze medical bills including EOBs for: 1) reasonableness of cost; 2) medically unnecessary treatment by physicians and hospitals; and 3) fraud
• Reviewing bills meeting criteria to ensure that all steps have been taken to receive the largest negotiated discounts.
• Compiling cost data and using clinical review to include in reduction of medical bills.
• Obtaining signed settlement agreements from providers.
• Update bill notes and follow-up on pending cases.
• Provide feedback to the members on the status of their case.
• Maintaining acceptable turnaround time of 5-7 days.
• Monitoring individual negotiation queues and working inventory daily.
• Contacting provider offices to discuss billed charges based on cost data and clinical review.
• Faxing settlement offers to providers detailing payment terms.
• Educate and assists members in navigating and helping them reduce their healthcare cost.
• Coordinates communication between patients and their physicians, case managers and other medical staff when necessary.
• Works with healthcare facilities to schedule doctor visits and therapy sessions for patients
• Verifies health insurance coverage for patients.
• Other duties may be assigned.

Requirements and Qualifications

• High school diploma required; College degree with a Healthcare focus preferred.
• Certification in a related field (CPC, RHIA, RHIT) a plus.
• Experience in medical billing or medical claims review preferred.
• 3 years previous healthcare or insurance industry experience is required.
• Must have excellent negotiation and persuasion skills.
• Strong computer skills in data entry, coding, and knowledge of Electronic Medical Record software; Microsoft Office Suite
• Ability to work in a high production environment.
• Knowledge of medical terminology, ICD-10, CPT coding.
• High level of organization and time management skills.
• Excellent verbal and written communication skills
• Ability to work under pressure and independently to meet goals.
• Background in bill negotiation and case management a plus.

This is an exempt position working in our corporate office.  We offer a full benefit package including 401k retirement plan, medical, dental, vision, paid vacation, life insurance and a competitive salary package.