At Plotkin Health, we specialize in all facets of medical loss mitigation, equally serving providers of medical service, health insurers and re-insurers of Medical Travel Insurance, both US based and internationally. Plotkin Health is a subsidiary of MacroHealth Solutions USA and we have over a two decade track record in settling medical provider claims. We seamlessly navigate the complex ecosystem of high-value medical provider claims settlement.

We are looking for a Claims Negotiator/Admin to join our Claims Settlement Team. You will be responsible for pro-actively building relationships with medical providers, following up with hospitals and health care providers to secure and process settlements relating to medical claims and payments, documenting all customer and provider interactions, and supporting the rest of the negotiation team as needed.

At Plotkin Health, our success is directly related to our ability to work together as a team–and the contributions of innovative team members are what keep us at the forefront of our industry.

Position Summary:

Relationship building skills are important as this position maintains regular telephone contact with key Medical Providers to enhance business relationships and claim arbitration. Maintaining accurate records and identifying the appropriate contacts and provider groups is an integral part of this role. You will be responsible for ensuring both fair and reproducible results are consistently achieved by bringing payors and providers to the table to reach an equitable settlement. 

Key Accountabilities:

• Communicate with out-of-network providers to negotiate claim payment on behalf of assigned payors
• Monitor and follow-up until resolution is obtained
• Identify options and processes to achieve the highest level of discounts
• Provide Negotiation Agreement and Repricing to payor
• Identify providers that should be forwarded for recruiting into the network
• Maintain tracking mechanism to ensure timely return of all claims
• Document all provider and customer encounters
• Update payor and provider profiles and contacts as appropriate
• Other duties and special projects as assigned

Knowledge, Skills and Abilities:

• Knowledge of Medical Claims and reimbursement
• Has a demonstrated history of working with medical claims at US providers 
• Commitment to deliver superior quality customer service on the phone, over video calls and emails
• 2+ years of healthcare experience
• Understands US Facility and Professional Fee Billing, CPT, DRG Codes,etc
• Demonstrate knowledge of eligibility, insurance policies and reimbursement
• Excellent organization, project management and oral/written communications skills
• Working knowledge of Microsoft Windows, Outlook, Work, Excel
• Demonstrated ability to work in a fast-paced team environment
• Detail oriented with ability to handle multiple assignments promptly and effectively
• Ability to navigate through a computerized system and other relevant applications while interacting with representatives on the phone
• Adaptive technical experience, demonstrating the ability to work with Microsoft Office and Custom applications
• Empathy, flexibility and patience in speaking with challenging representatives
• Excellent discretion and judgment skills
• Excellent probing and creative problem solving skills
• Ability to absorb and apply new and changing information

Preferred Education and Experience:

• Bachelor Degree (BA/BS)
• Billing/Coding Certification or equivalent business experience
• Patient collections or healthcare negotiation experience.
• Bilingual – fluent in both English and Spanish or French an asset

Salary: CAD $60,000 - $65,000

Core Competencies:

One Team: 

• Act as one team with fellow MacroMates and customers
• Value humility, low ego, and collaboration
• Maintain an All for One, One for All attitude 

Deliver on Promises: 

• Do the right thing
• Do what you say you will do
• Work with a sense of urgency and transparency

Macro Thinking:  

• Challenge yourself and others to think boldly, bigger, and into the future
• Lead with a Growth Mindset
• Act as a thought leader for the healthcare industry

Plotkin Health is an equal opportunity employer.