Job Details

JOB PURPOSE:

Ensure all proposed negotiations are thoroughly reviewed, researched, and responded to in a timely and

appropriate manner. This position is also responsible for collecting, organizing, and analyzing negotiation data to improve the predictability of accepted offers, counters, and rejections.

Job Duties and Responsibilities:

1. Initiate proactive daily outreach to negotiators to confirm receipt of responses or clarify

counterarguments, ensuring effective communication and resolution of any discrepancies in the negotiation process.

2. Take full ownership of follow-up, research, and coordination efforts to identify and track proposed

negotiations across various channels, including the portal, scanned documents, faxes, and emails,

ensuring that all relevant data is organized and easily accessible.

3. Document and update critical information in Collaborate MD regarding payments, ensuring that all

entries are accurate and timely, and effectively organize work schedules around Jira due dates to

maintain workflow consistency.

4. Verify and confirm the finalization and processing of negotiated rates, ensuring all payments are

executed correctly and promptly, while directing any irregularities or discrepancies to the payment

auditor for resolution.

5. Leverage multiple data sources, including but not limited to CMD, Anthem Claims Routing tool, Kipu,

Reimbursement Tool, and Availity, to analyze past payment rates and identify patterns for similar

members or facilities, enhancing decision-making and negotiation strategies.

6. Escalate complex claims and challenges promptly to the Negotiations Lead, ensuring that all concerns

are addressed in a timely and effective manner, while maintaining a high standard of customer service

and issue resolution.

7. Maintain awareness of net gain/loss metrics and KPIs to stay in touch with the outcomes of assigned

work, and use this insight to inform priorities, performance, and improvement opportunities.

8. Participate in the department's L10 meetings, identify and bring issues, and develop and execute

quarterly rocks to drive alignment and improvements toward Cipher VTO.

9. Performs other related duties as assigned.

Minimum Qualifications

• High School Diploma or equivalent
• 2 years' professional experience
• 1+ Year Healthcare Experience Preferred
• EOS Knowledge/Understanding Preferred
• Proficient in Atlassian Products (Jira & Confluence) Preferred