We’re looking for…
A Provider Contracting and Negotiating Specialist who will be responsible for working on behalf of the client to negotiate their out of network claims when applicable. You will work directly with out of network providers to work out a single case agreement/fee or direct contract for submitted medical claims.
Who are you?
- You can demonstrate the ability to influence stakeholders and achieve mutually agreeable outcomes.
- You can communicate clearly and professionally with both internal and external customers.
- You are able to make well-informed decisions using available resources and sound judgment.
- You are able to proactively identify and resolve issues in a timely manner, gathering and analyzing information effectively.
- You are have an eye for detail and great time management skills
- You are able to adapt to changes in the work environment, manage competing demands, and handle frequent changes, delays, or unexpected events with ease.
What’s the role?
You will be responsible for:
- Initiate contact with out-of-network provider offices, managing requests from a designated queue.
- Negotiate fees and rates with out-of-network providers to ensure cost-effective service delivery.
- Accurately perform data entry and documentation related to the repricing of medical claims.
- Communicate with providers through various channels (e.g., phone, email, fax) and diligently record all interactions and progress.
- Oversee the claims process to ensure timely and accurate adjudication.
- Process out-of-network claims efficiently and in accordance with established guidelines.
- Maintain up-to-date communications to provide timely responses and support within the assigned turnaround time.
- Collaborate directly with clients and other departments to address and fulfill negotiation requests.
Boxes to tick…
- Matric
- Diploma or equivalent
- 1 year of provider contracting, data or network administration experience preferably in a healthcare third party administrator setting or 2 years of claims processing or customer service experience in a medical/healthcare setting including knowledge of medical terminology
- Prior work in production environment
- You are able to maintain confidentiality and exercise discretion in handling sensitive information
- You are proficient in Microsoft Office
Working Hours: 2pm - 11pm