Negotiator Analyst (Level I)

Hispanic Alliance for Career Enhancement; United States; Remote; USD 43,000 - 103,000; Full time

Job summary

A leading health solutions company in the United States is seeking a Negotiator Analyst to negotiate out-of-network medical claims. The ideal candidate will have 3-5 years of medical claims experience and strong communication skills. Join a team dedicated to transforming healthcare and enjoy a wide range of benefits including medical, 401(k), and employee stock purchase plans.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Paid time off

Tuition assistance

Qualifications

• 3-5 years of experience in a medical claims background.
• Demonstrated ability and strong understanding of benchmarking costs for medical services.
• Previous medical provider/business office phone call handling experience.

Responsibilities

• Learn to navigate the systems for this role.
• Develop filing, naming conventions, and documentation processes.
• Conduct checklist workups and manage outbound communications.

Skills

Medical claims analysis

Phone call handling

Mathematical skills

Written communication

Verbal communication

Education

Associates/High School degree or equivalent experience

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

The Negotiator Analyst is responsible for negotiating out-of-network (OON) medical claims valued at $10,000 and above. This role involves learning the negotiation role, and understanding (U&C) calculated rates and benchmarking of medical costs. The individual will be developing their role as a negotiator, working with training staff, and team members as more complex cases and strategies are developed.

What you will do

• Learn to navigate the systems, and create networking, for this role
• Develop filing, naming conventions, and documentation processes
• Conduct checklist workups and manage outbound communications via phone, fax, and email to facilitate negotiations.
• Work up and organize daily cases
• Make outbound calls, develop provider contacts, and understand production metrics

Required Qualifications

• 3-5 years of experience in a medical claim background with demonstrated ability and strong understanding of benchmarking costs for medical services, supplies, and drugs.
• Previous medical provider/business office phone call handling history.
• Strengths in mathematical, written, and verbal skills.

Preferred Qualifications

• Coding experience, CMS, and/or CPC Certification.
• Proficient in Usual and Customary (calculations) and cost-benchmarking for drugs, supplies, and services.

Education

• Associates/High School graduate, or equivalent professional work experience.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $43,888.00 - $102,081.00

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.