Member Advocate – Negotiator

Christian Care Ministry

Orlando (FL)

On-site

USD 66,500 - 90,500

Full time

14 days+

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Benefits offered by this job

100% paid Medical for employees

Generous employer Health Savings Account contributions

401(k) plan with match

Job summary

Christian Care Ministry is seeking a Member Advocate - Negotiator in Orlando, FL to resolve balance bills by negotiating directly with providers on behalf of members. This role requires understanding of Medicare reimbursement rates and negotiating directly with healthcare facilities.

The ideal candidate will possess strong communication skills, a bachelor's degree in a relevant field, and at least 3 years of experience in healthcare payment negotiation.

This is a hybrid position, requiring onsite work at least 4 times per week.

Qualifications

3+ years of experience in healthcare payment negotiation or provider relations.
Strong understanding of Medicare reimbursement rates and negotiation strategies.
Experience negotiating directly with hospitals and facilities.

Responsibilities

Negotiate directly with providers on behalf of members.
Document all negotiation activity and manage case files.
Collaborate with team members and escalate unresolved cases.

Skills

Negotiation skills

Communication skills

CPT/ICD coding knowledge

Documentation habits

Proficient in Microsoft Office

Education

Bachelor's degree in healthcare administration, Business, or Finance

Job description

Member Advocate - Negotiator

Orlando, FL | Hybrid

The range for this role is $66,500.00 - $90,500.00. Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. Interested applicants must be willing and able to work onsite minimum 4 times per week in our Orlando, FL office.

The Job

The Member Advocate Negotiator works in close partnership with the Member Bill Advocate to resolve balance bills by engaging and negotiating directly with the provider or facility that issued the bill to the member. The Negotiator applies knowledge of Medicare reimbursement rates, market benchmarks, payer-provider fee schedules to anchor and advance negotiations toward a settlement that protects the member from unexpected out-of-network charges. The role owns the full negotiation lifecycle from case assignment through settlement execution and case closure. At lower activation scenarios, the Negotiator's significant spare capacity supports provider contracting and network analytics.

Essential Job Duties & Responsibilities

Collaboration with the Member Advocate

Receive balance-bill cases from the Member Advocate following intake, eligibility verification, and pathway determination; review the case file for completeness before initiating negotiation
Coordinate with the assigned Member Advocate on member context, prior provider communications, and any sensitivities that should shape negotiation tone or approach
Provide settlement updates and projected closure timeline to the Member Advocate on a defined cadence so the Advocate can keep the member informed within SLA windows
Hand back to the Member Advocate at settlement for member confirmation, CSAT capture, and case closure in the case management system

Negotiation Strategy & Preparation

Research Medicare, market benchmarks, and applicable fee schedules to develop negotiation strategy and opening offers for each case
Review provider claims for CPT/ICD coding accuracy, and billing reasonableness prior to negotiation; flag suspected coding errors or upcoding for Paralegal review when warranted
Prepare a documented negotiation plan for each case identifying opening offer, target range, walk‑away threshold, and supporting evidence

Direct Provider Engagement & Settlement

Conduct direct payment negotiations with the provider or facility that issued the balance bill to the member, on the member's behalf
Manage the full negotiation lifecycle: provider outreach, counter‑offer cycles, settlement execution, and case closure
Operate within Negotiator‑defined settlement authority thresholds; obtain Advocacy Team Manager authorization for settlement parameters that exceed those thresholds
Where the case has been routed through delegation, partner with the delegated team or assume internal handling per the established hand‑off criteria; ensure no duplicative provider outreach

Documentation & Case Management

Document all negotiation activity, communications, and settlement terms in the case management system in real time and to audit‑ready standards
Maintain accurate, current case status so that the Member Advocate, Manager, and any delegated vendor can rely on a single source of truth for the case

Cross‑Team Coordination & Escalation

Collaborate with paralegals on legal case file preparation for complex, high‑dollar, or multi‑party negotiations
Escalate unresolvable cases to the Advocacy Team Manager and coordinate transition to alternative dispute resolution, third‑party arbitration, or external legal counsel as authorized
Coordinate with Claims, Network Management, or Provider Relations when a negotiation reveals a contracting, configuration, or claim‑processing issue requiring upstream correction

Pattern Identification & Continuous Improvement

Identify recurring provider billing patterns and report systemic issues to the Advocacy Team Manager for network‑level correction
Maintain current knowledge of applicable state balance billing law and the organization's sharing program guidelines as they affect provider negotiation strategy
Contribute lessons learned and successful negotiation tactics back to the team's playbook and training materials
Contribute to the exercise and expression of Christian Care Ministry's Christian beliefs
All other duties as assigned

Essential Skills & Abilities

Advanced understanding of Program Guidelines to all member/provider issues
Strong written and verbal communication skill able to explain settlement positions clearly to providers, members, and internal stakeholders
Disciplined documentation habits and proficiency with case management systems
Proficiency with CPT/ICD coding and Medicare fee schedule analysis
Understanding of managed care contracts
Negotiation skill able to negotiate directly with hospital, facilities, and physician group medical billing office personnel at all levels
Ability to read, interpret and apply vendor and provider contracts
Knowledge and skill applying applicable state balance billing laws with the organizations policies, guidelines, and practices
Ability to apply common sense understanding to carry out instruction furnished in written, oral or diagram form; deal with problems involving several variables in standardized situations
Understanding of multi‑band or multi‑tier provider network program structures and delegated payment‑integrity operations
Proficiency with Microsoft Office Suite (Excel, Word, Outlook, Teams, PowerPoint)

Core Competencies/Demonstrable Behaviors

Manages Conflict handles conflict situations effectively.
Drives Results consistently achieves results, even under tough circumstances and tight deadlines.
Courage ability to have tough conversations and deliver accurate advice and decisions regardless of risk or potential criticism
Member First exhibits full commitment to serving members and/or clients by prioritizing their needs first in alignment with our program's purpose. This commitment is demonstrated through understanding of the program(s), provided through quality and timely service while exercising empathy in every interaction. Every CCM employee shares responsibility to steward resources faithfully, removing barriers to understanding, and creating accessible, connected, and Christ-centered experiences.
Humble demonstrates Christ-Centered humility by honoring others, accepting feedback, and prioritizing collective success over individual recognition
Hungry exhibits initiative, perseverance, and commitment to serving God through excellence. Demonstrates passion for personal and organizational growth while diligently advancing the mission of Christian Care Ministry
Smart shows relational and emotional intelligence, communicates effectively, collaborates harmoniously, and reads social cues with grace and discernment

Education and/or Experience

Bachelor's degree in healthcare administration, Business, or Finance, required; combination of education or equivalent experience may satisfy this requirement
3+ years of experience in healthcare payment negotiation, provider contracting, or provider relations, required
Demonstrated experience negotiating directly with hospitals, facilities, or physicians' groups required
Experiencing operating within or alongside a delegated payment‑integrity / provider dispute vendor relationship a strong plus
Familiarity with healthcare sharing models and shared‑eligibility determinations a plus
Prior experience handling third‑party arbitration filings and working with managed care contracts preferred

Supervisory Responsibilities

This job has no supervisory responsibilities

Travel

Minimal travel may be required for provider meetings or training events

Incentives & Benefits

We work hard to serve our Medi‑Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.

For full‑time employees working 30 hours or more, some of our benefits include, but are not limited to: