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