Provider Contracting

2 months ago


Woodmead, South Africa HR Outsource Full time

**Job Summary**:
The Provider Contracting and Negotiating Specialist I is responsible for working on behalf of the client to negotiate their out of network claims when applicable. This person will work directly with out of network providers to work out a single case agreement/fee or direct contract for submitted medical claims. The client is internationally based, so after-hours work, aligned with the client’s business hours in their country, will be required. This is a fixed-term role with the potential for permanent employment, based on the client’s ongoing needs.

**Duties and Responsibilities**
- Initiate contact with provider offices for out of network services working from a queue
- Negotiate fees and rates with out of network providers
- Perform data entry and documentation of repricing of medical claims
- Oversee process to ensure claim is adjudicated
- Process out of network claims
- Keep communications current to provide responses and support within the assigned turn-around time
- Liaise directly with clients and other departments on negotiation requests

**Required Knowledge, Skills and Abilities**
- HS Diploma or equivalent
- 1 year of provider contracting, data or network administration experience preferably in a healthcare third party administrator setting or 2 years of claims processing or customer service experience in a medical/healthcare setting including knowledge of medical terminology
- Prior work in production environment

**Job Type**: Temp to perm

Pay: R12 000,00 - R20 000,00 per month


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