Job Description
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