Prepay Claim Negotiation Associate Englewood, CO
Business Consulting: Includes analysis/evaluation of business and/or system process and functional requirements, development of business cases, client support during system development and implementation, development and maintenance of service level agreements. Develops relationships with upstream and downstream business partners. Develops/maintains and changes business processes, and understands the business processes of assigned partners and how they relate to our functional areas. Develops and recommends changes to business processes.
The Prepay Claim Negotiation Associate is responsible for achieving claim discounts on non-par/contracted provider claims through a vendor supported process. Develops relationships with upstream and downstream business partners. Develops/maintains and changes business processes, and understands the business processes of assigned partners and how they relate to our functional areas. Develops and recommends changes to business processes. The Associate should:
Knowledge and understanding of rental networks, provider contracts, and claim payment methodology to determine appropriate discount potential.
Knowledge of CMS, Medicaid, and Commercial claim reimbursement methodology.
Proficient in systems and research tools to manage data and aid investigation of claim payment.
Assures accurate and timely resolution of processing claims, inquiries and concerns.
Demonstrates interpersonal communication skills by working collaboratively and effectively with all levels of peers, leadership and outside entities.
- Knowledge of application of standard principles, theories, and techniques.
- Uses professional concepts and company policies and procedures to solve a wide range of difficult problems in imaginative and practical ways.
- Demonstrates development of positive relationships with peers.
- Understand their functional area business processes.
- Is assigned to investigate, document, and analyze client requirements in project areas such as: new/existing business operating models with innovative approaches to applicable department solutions support, market research of emerging or available product functionality and operational readiness assessment.
- Assesses scope and impact of client business needs.
- Support Business Case Development.
- Participates in the analysis of client business processes and functional requirements and in the preparation of appropriate documentation to communicate and validate the information.
- Participates in workflows, process diagrams and gap analysis.
- May assist in the development of project plans.
- May use the associated project planning tools.
- Bachelor's degree in business/health care administration or related discipline OR four (4) years relevant experience.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Business analysis or project analysis experience.
- Knowledge of platforms assigned to the functional area.
- Identifies and documents functional and/or divisional, requirements, workflow, information sources and distribution paths, and system/process specifications.
- Must be able to work in a Labor/Management Partnership environment.
- Bachelor-s Degree in Business, Healthcare Administration or related fields; or an equivalent combination of education, training and experience is required.
- A minimum of 3 years work experience in cost containment/payment integrity and/or claims processing.
- Ability to interact, collaborate and communicate with stakeholders at all levels within the organization including analysts, IT and business leaders.
- Excellent time management/prioritization skills with demonstrated ability to handle multiple tasks, shifting priorities and meeting deadlines.
- Demonstrated ability to think and act independently and professionally.
- Possesses excellent communication skills, team building skills and the ability to work effectively with diverse team members.
Primary Location: Colorado,Englewood,Englewood MSSA 9800 S. Meridian Blvd.
Scheduled Hours (1-40): 40
Working Days: Mon-Fri
Job Type: Standard
Employee Status: Regular
Employee Group: Salaried, Non-Union, Exempt
Job Level: Individual Contributor
Job: Consulting Services / Project/Program Management (Non IT)
Public Department Name: National Payment Integrity
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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