A call agent specializing in medical repricing will manage phone-based interactions, helping to negotiate, explain, and facilitate the process of adjusting healthcare service costs between healthcare providers, insurance companies, and patients. This role requires effective communication, attention to detail, and a good understanding of healthcare billing processes.
Key Responsibilities:
Handle calls related to medical claim pricing, adjustments, and disputes.
Initiate contact with healthcare providers, insurance companies, and patients to negotiate pricing.
Medical Claim Review:
Review medical bills, coding, and charges to ensure they align with insurance policies and contracts.
Explain medical pricing and billing details to providers and patients when necessary.
Discuss and negotiate cost adjustments with healthcare providers based on established contracts.
Facilitate agreement on fair pricing between parties.
Data Entry & Documentation:
Accurately document all call interactions and outcomes in internal systems.
Ensure proper coding and documentation for repricing claims.
Customer Support:
Address queries related to medical billing and pricing.
Provide clarification on insurance coverage and payment responsibilities.
Collaborate with Teams:
Work with internal teams (e.g., claims, billing, customer service) to ensure proper resolution of repricing issues.
Communicate with external partners, including doctors, hospitals, and insurance companies.
Maintain Compliance:
Stay informed about industry regulations, healthcare laws, and HIPAA standards.
Ensure all actions are compliant with legal and regulatory requirements.
Skills & Qualifications:
Strong communication skills (verbal and written).
Basic knowledge of medical billing, coding, and insurance terminology.
Ability to handle confidential information in accordance with HIPAA.
Good negotiation skills and conflict resolution abilities.
Attention to detail and accuracy in documentation.
Proficiency in using call center software and healthcare management systems.
Ability to multitask and manage time effectively.
Customer service experience, preferably in the healthcare or insurance sector.
Education & Experience:
High school diploma or equivalent (required).
Previous experience in medical billing, healthcare customer service, or repricing (preferred).
Certification in medical billing/coding (a plus).#J-18808-Ljbffr