Negotiations Specialist

Department: RCM: Revenue Optimization & Operations

Location: Headquarters - Matawan

Compensation: $20.00 - $30.00 / hour

Description Negotiations Specialist Location: REMOTE

Entity: Alliance Health System

Reports To: Director of RCM

At Alliance Health System, our goal is to help our clients get their patients better faster, so that they can get back to doing the things they love. Accordingly, our approach to healthcare management is different: we seek to aid our clients in structuring treatment plans with patients, rather than for patients. We help clients ensure that their patients’ goals can truly be their top priority by simplifying the process of running a practice. In short, we provide our clients with the best experience possible so that they can focus on their patients who, in turn, can Get Better Faster.

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.

Summary of Responsibilities 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.

Job Type:

• Full-Time
• Monday-Friday
• Remote

Benefits

• 401(k) matching
• Medical, Dental & Vision
• Paid Time Off
• Sick Time
• Paid Holidays

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.