Join a high-performing team dedicated to reducing healthcare costs by securing accurate and fair payments on medical claims. As a Medical Claims Negotiation Specialist, you'll play a crucial role in analyzing provider billing data, identifying errors, and negotiating reimbursements directly influencing cost-containment outcomes and operational efficiency.

Position: Medical Claims Negotiation Specialist
Location:  Fort Worth, TX | Remote (must reside locally)

Pay: $19 $20/hour
Direct Hire
Schedule: Monday - Friday, 8am - 5pm

JOB ID: 150517

KEY RESPONSIBILITIES
Analyze billing histories and prior negotiations to determine a negotiation strategy
Review internal reports and professional findings to validate billing errors
Consult with clinical staff as needed to prepare for provider outreach
Communicate with providers to present billing discrepancies and justify charge adjustments
Negotiate corrections, fee removals, and adjusted payments on facility, professional, RX, and appeal/litigation claims
Secure formal agreement through signed Letters of Agreement

MINIMUM QUALIFICATIONS
3+ years experience in medical claims processing or PPO negotiation in managed care or benefits administration
2+ years of customer service experience in healthcare payer environments
In-depth knowledge of Workers Compensation fee schedules and healthcare regulations
Proven record of negotiating Group Health, Workers' Comp, Auto, and Liability claims
Strong skills in EHR systems, medical coding basics, and healthcare terminology
Prior work-from-home experience with a secure, private workspace
Reliable high-speed internet (minimum 35 Mbps download/upload, no hotspot)

CORE TOOLS & SYSTEMS
Internal billing platforms
Electronic Health Records (EHRs)
Microsoft Office Suite

PREFERRED SKILLS
Experience resolving benefit payment disputes and first-level provider appeals
Strong written and verbal communication abilities
Detail-oriented with analytical and investigative strengths

LEGAL NOTICE
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