Responsibilities: • Assist and educate 1199SEIU members and providers with out of network fees and out of pocket expenses on the contracts and benefits of using the Funds network • Negotiate and resolve large volume of c…
Skills: Balance Billing, Fee Negotiation, No Surprises Act, Claims Processing, Medical Billing
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Full-time
associate degree
Posted 39d ago
~40 hrs/week
Responsibilities
Negotiate and resolve complex balance billing inquiries and out-of-network fees for members and providers. Manage claims impacted by the No Surprises Act to avoid escalation to Independent Dispute Resolution while maintaining tracking databases and reports.
Requirements
Requires an associate degree or equivalent experience with at least three years of medical claims processing and two years of negotiation experience. Must possess comprehensive knowledge of the No Surprises Act and proficiency in Microsoft Office Suite.
Full job description
Responsibilities:
Assist and educate 1199SEIU members and providers with out of network fees and out of pocket expenses on the contracts and benefits of using the Funds network • Negotiate and resolve large volume of complex, high dollar balance billing inquires fees and discounts for members with non-participating providers via telephone and written correspondence; maintain ongoing communication with providers, members, attorneys, or collection agencies to resolve balance billing/fee negotiation inquiries • Proactively negotiate claims impacted by the No Surprises Act (NSA), focusing on resolving disputes with out-of-network providers to avoid escalation to Independent Dispute Resolution (IDR). This includes leveraging communication and negotiation strategies to achieve mutually agreeable payment solutions. Assess claim details and potential outcomes to determine when negotiation is more beneficial than escalating to IDR, utilizing various benchmarks. • Oversee and update internal channels to ensure access to accurate information regarding Balance Billing requirements • Utilize the various databases to assess and compute reasonable rates, negotiating claim payments with providers, attorneys, and collection agencies on behalf of members. • Assist in developing and maintaining reporting structures for NSA claims, tracking key metrics such as settlement rates, cases escalated to IDR, and overall compliance with NSA guidelines. • Assist in generating and presenting detailed reports on NSA-related claim outcomes, including the volume of claims negotiated successfully, claims escalated to IDR, and resolution timelines, providing these insights to management for strategic planning. • Contribute to developing, maintaining, and monitoring tracking databases to enhance the Balance Billing Department's functions and improve overall workflow efficiency. • Assist in training new and current staff on balance billing and fee negotiation procedures to meet department performance standards. • Collaborate closely with the Manager of Balance Billing Fee Negotiation to track, report, and achieve departmental goals. • Proactively identify and communicate any barriers to achieving departmental objectives to management. • Support management in coordinating and executing Balance Billing Department workflow initiatives and projects. • Assist in preparing and presenting daily, weekly, and monthly tracking reports to management, highlighting key trends and outcomes. • Conduct research and provide recommendations for process improvements, enhancing the efficiency and effectiveness of operations. • Perform special projects and other duties as assigned by management.
Qualifications:
Associates degree or the equivalent years’ experience. • Minimum three (3) years hospital and medical claims processing experience and minimum two (2) years of negotiation experience required • Excellent knowledge of health claims, eligibility rules, Coordination of Benefits (COB) • Familiarity with the No Surprises Act (NSA): Comprehensive knowledge of NSA regulations, including experience navigating surprise billing protections, Independent Dispute Resolution (IDR) processes, and the Qualified Payment Amount (QPA). • Excellent critical thinking, attention to detail and problem-solving skills; able to work well independently and as a team player. Demonstrate analytical and organizational skills with ability to multi-task and meet operational deadlines • Excellent math skills and the ability to translate mathematical information into concise reports. Ability to conduct various data comparison analysis, working knowledge of macros, tables, forms, queries and reports necessary • Proficiency in Microsoft Office (Word, Excel, Access, Outlook etc.). Ability to grasp and utilize new software systems • Ability to work well under pressure, maintain professional manner and presentation
The 1199SEIU Training and Employment Funds provide eligible 1199SEIU members with educational services and programs.
Industry
Hospitals and Health Care
Company size
201-500 employees
Founded
1969
Headquarters
New York, NY
LinkedIn followers
3,702
The mission of the 1199SEIU Training and Employment Funds is to help 1199SEIU members obtain high quality training in order to move into upgraded positions, thereby strengthening the healthcare system.
We respond to educational and outreach requests of union officials and employers who contribute to the Training Fund, and other 1199SEIU Funds.
The Education Department, along with other departments within the Training Fund, provides eligible members with a wide range of educational services and programs ranging from high school completion to college and professional programs.
The Training Fund offers educational counseling and admissions services to members who are eligible applicants. Members can access these services at several places depending upon the location most convenient to them.
The current locations where counseling and admissions services are available are Manhattan, Bronx, Brooklyn, Long Island, Staten Island and White Plains.
Offices: 498 Seventh Avenue, New York, NY 10018, US · 25 Elm Pl, 1st Floor, Brooklyn, New York 11201, US · 2501 Grand Concourse, Bronx, New York 10458, US · 790 Port Richmond Ave, Staten Island, New York 10302, US · 100 Duffy Ave, 3rd Floor, Hicksville, New York 11801, US
TrainingWorkforce developmentEducationWorkplace skillsHealthcare employmentHealthcare workersNursing1199SEIU membersHigh School Completionand College
How many Healthcare jobs are open in New York, NY right now?
There are currently 11,601 open healthcare positions in New York, NY listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in New York, NY?
Companies currently hiring include Mount Sinai Health System, Northwell Health, New York City Housing Authority (NYCHA), CVS Health, NewYork-Presbyterian Hospital, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in New York, NY?
Yes — 2454 of the 11601 open healthcare positions offer remote or hybrid work (557 remote, 1897 hybrid).
How do I apply for Healthcare jobs in New York, NY?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.