Negotiations and Repricing Specialist

4 weeks ago

Misamis Oriental Philippines Clinovation Corp. Full time

Key Responsibilities Repricing & Collections Review medical claims for accuracy and ensure they are priced according to payer contracts and fee schedules. Identify discrepancies in reimbursement and initiate corrective actions, such as adjustments or appeals. Monitor underpaid or incorrectly paid claims and resolve issues through follow-up and negotiation. Collaborate with insurance companies to negotiate payment rates for out-of-network claims when applicable. Stay updated on payer‑specific rules, regulations, and changes in fee schedules. Revenue Optimization Analyze trends in collections and repricing to identify opportunities for improved workflows. Collaborate with the Billing Manager to establish and refine policies for optimal claim management. Develop strategies for minimizing claim denials and maximizing reimbursement. Documentation & Communication Maintain detailed records of payer communications, adjustments, and resolutions. Prepare and distribute reports summarizing collections performance, trends, and outstanding issues. Act as a liaison between the clinic and payers to address concerns and resolve disputes professionally. Compliance Ensure all repricing and collection activities comply with federal, state, and payer regulations, including HIPAA. Conduct periodic audits of repriced claims to ensure accuracy and compliance. Qualifications Education & Experience High school diploma or equivalent; an associate’s or bachelor’s degree in healthcare administration, business, or a related field is preferred. Minimum of 2–3 years of experience in medical billing, collections, or payer negotiations, preferably in a vein or pain clinic. Skills & Competencies Proficiency in medical billing systems (e.g., Kareo, AdvancedMD, or similar software). Strong understanding of CPT codes, ICD‑10 codes, and payer fee schedules. Excellent negotiation and problem‑solving skills. Strong analytical abilities and attention to detail. Effective communication skills, both verbal and written. Ability to manage multiple tasks and meet deadlines in a fast‑paced environment. Certifications (Preferred but Not Required) Certified Professional Biller (CPB) or Certified Professional Coder (CPC). What We Offer: Competitive salary Comprehensive benefits package, including health, dental, insurance. Paid time off and holiday pay. SSS, Pag‑IBIG, and PhilHealth – 100% covered by Clinovation Corp. (No salary deductions ) #J-18808-Ljbffr

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