Medical Claims Associate II at SphereMD – Vancouver, Washington

Primary Purpose: The Medical Claims Associate manages routine and complex files requiring collection, auditing, and negotiation of claims generated from care provided to uninsured mariners who live and work aboard commercial shipping vessels.

Essential Duties and Responsibilities:

• Mentors Claims Assistants on routine claims matters.
• Manage a high volume of phone calls and emails received from parties around the world.
• Keep current with all claims actions and meet client and company deadlines for completion of claims.
• Follow internal procedures to identify appropriate discount methodologies.
• Conduct price negotiations on bills to reduce overall costs to clients and escalate to supervisors when appropriate.
• Work to overcome negotiation objections by applying effective negotiation skills and addressing counteroffers to reach successful resolution on claims.
• Seek opportunities to achieve savings with previously challenging/unsuccessful providers.
• Nurture client relationships by providing detailed and timely updates throughout the claims process, in both verbal and written communications.
• Develop provider relationships to facilitate current and future claims resolutions.
• Prepare routine and complex client invoices in a timely and accurate manner.
• Adhere to department procedures, guidelines, and goals.
• Perform administrative duties related to claims work.
• Collaborate, coordinate, and communicate across departments as needed.
• Other duties as assigned.

Required Knowledge, Skills, and Abilities:

• Ability to analyze new information quickly and determine an effective and appropriate course of action.
• Ability to work well under pressure in a complex and rapidly changing environment.
• Strong organizational skills with attention to detail.
• Ability to meet deadlines while managing an active and diverse caseload.
• Strong interpersonal, written, and verbal communication skills.
• Ability to multi-task and prioritize (and re-prioritize) as needed.
• Ability to assert oneself over the phone for the purpose of negotiation.
• Ability to learn and follow SphereMD administrative policies and procedures.
• Ability to work both independently and interdependently with staff and team members with limited supervision.
• Ability to maintain a friendly, professional demeanor.
• Ability to maintain regular and reliable attendance and punctuality.
• Entrepreneurial spirit that likes to think of new, more efficient ways to do things. Can identify new opportunities, formulate thoughtful plans, and present them to leadership for feedback and approval.
• Working knowledge and application of medical terminology and standard billing codes is a plus.
• Consistent, dependable work effort and a positive work attitude.
• Advanced skills in Microsoft Word, Excel, Outlook, and ability to learn new software. QuickBooks experience is a plus.
• Ability to maintain an attitude of respect for others and a commitment to get the job done.

Minimum Experience Required:

To perform this job successfully, the following experience is required for the Medical Claims Associate:

• Experience: At least 2 years of experience in a professional office environment with high administrative duties. Experience in accounting, medical billing, or claims is helpful although not required.
• Education: High school diploma or its equivalent. Associates degree or higher is preferred. An equivalent combination of experience and/or education will be considered.