Medical Claims Negotiation Specialist
Join a high-performing team dedicated to reducing healthcare costs by securing accurate and fair payments on medical claims. As a Medical Claims Negotiation Specialist, you'll play a crucial role in analyzing provider billing data, identifying errors, and negotiating reimbursements—directly influencing cost-containment outcomes and operational efficiency.
Position: Medical Claims Negotiation Specialist
Location: Fort Worth, TX | Remote (must reside locally)
Pay: $19–$20/hour
Direct Hire
Schedule: Monday - Friday, 8am - 5pm
JOB ID: 150517
KEY RESPONSIBILITIES
Analyze billing histories and prior negotiations to determine a negotiation strategy
Review internal reports and professional findings to validate billing errors
Consult with clinical staff as needed to prepare for provider outreach
Communicate with providers to present billing discrepancies and justify charge adjustments
Negotiate corrections, fee removals, and adjusted payments on facility, professional, RX, and appeal/litigation claims
Secure formal agreement through signed Letters of Agreement
MINIMUM QUALIFICATIONS
Must have previous fee negotiations, usual and customary fee schedules, or claims reimbursement experience.
3+ years’ experience in medical claims processing or PPO negotiation in managed care or benefits administration
2+ years of customer service experience in healthcare payer environments
In-depth knowledge of Workers’ Compensation fee schedules and healthcare regulations
Proven record of negotiating Group Health, Workers' Comp, Auto, and Liability claims
Strong skills in EHR systems, medical coding basics, and healthcare terminology
Prior work-from-home experience with a secure, private workspace
Reliable high-speed internet (minimum 35 Mbps download/upload, no hotspot)
CORE TOOLS & SYSTEMS
Internal billing platforms
Electronic Health Records (EHRs)
Microsoft Office Suite
PREFERRED SKILLS
Experience resolving benefit payment disputes and first-level provider appeals
Strong written and verbal communication abilities
Detail-oriented with analytical and investigative strengths
LEGAL NOTICE
By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from CornerStone and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at: https://www.cornerstonestaffing.com/privacy
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