Job Description

Relationship building skills are important as this position maintains regular telephone contact with key Medical Providers to enhance business relationships, and claim arbitration. Most importantly, you will be responsible for ensuring both fair and reproducible results are consistently achieved by bringing payors and providers to the table to reach an equitable settlement.  

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
• Fluent in Spanish

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.