Negotiations and Repricing Specialist

5 days ago

Cagayan de Oro, Northern Mindanao, 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)

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