**Please note: This position is with Nova, a division of Independent Health Corporation (a subsidiary of Independent Health).**
The Cost Containment Coordinator is responsible for coordinating efforts to control medical expense through negotiation with nonparticipating providers, facilitation of efforts with cost containment vendors, cross functional operational initiatives, pre-payment, concurrent and retrospective reviews of claims and medical records to assure payment is appropriate for services provided and that services rendered were medically necessary. Contribute to research and implementation of industry best practices in the area of cost containment, and ensuring the appropriate reimbursement for specific negotiated care management cases. Duties include assisting case managers in negotiating non-participating providers/non-contracted, out of area services, the preparing of monthly savings reports by line of business, notification to reinsurance carrier(s) of high dollar cases and ensuring proper and timely payment of such claims.
Three (3) years’ experience in a medical office or health insurance setting; demonstrated knowledge of claims processing/adjudication procedures with demonstrated capacity to grasp new processes and procedures; self-funded medical experience preferred.
Expertise in CPT and ICD-9/10 coding with strong knowledge of medical billing and reimbursement protocol, with emphasis on facility billing and reimbursement.
Experience with negotiation strategies related to health care claims.
Knowledge of physician networks, compensation, and alignment strategies and methodologies. Excellent knowledge and experience with medical policy, coding, claims payment and auditing clinical records to establish appropriate billing practices.
Demonstrated decision-making skills that incorporate the ability to assume responsibility and work independently.
Demonstrated knowledge in contracting with providers or in securing discount for services.
Excellent written, verbal and interpersonal communication skills.
Demonstrated transferable knowledge, skill and ability to complete job duties independently and proficiently. Flexibility in work schedules and assignments.
Ability to assume responsibility and maintain confidentiality.
Understands the importance of maintaining the physical and technical security and privacy of protected health information (PHI).
Independent Health is an equal opportunity employer.