Cost Containment Administrator Jobs

Job Overview

The Cost Containment Administrator will execute the company’s cost containment strategies necessary to obtain discounts on medical claims through direct negotiation from providers or through our contracted networks, investigating reasonable and customary rates for services in different geographic locations. This role requires excellent knowledge of the Canadian and USA Medicare systems and internationally, strong provider relations and negotiation skills, strong time management skills, and a good understanding of travel insurance policy interpretation and claims to handle.

Responsibilities

· Review and obtain discounts on medical bills from providers

· Coordinate repricing through our contracted networks

· Coordinate repricing through our direct contracts with providers

· Accurately update the repricing of bills in the claims system

· Follow up on urgent claims negotiated to ensure completion of payment as agreed with providers

· Obtain signed agreements with providers on negotiated bills

· Work with providers and clients to resolve balance billing issues

· Utilize various tools to determine reasonable and customary charges for services billed in order to maximize savings

· Identify providers for direct contracting to expand our direct networks

· Identify opportunities to streamline activities & make recommendations

Assists with reports summarizing cost containment savings

Qualifications and Education Requirements

· High school diploma or equivalent

· Minimum 2-3 years of previous claims administration experience

· High level of proficiency in MS Office Suite, specifically Word, and Excel

· Superior verbal and written communication skills

· Strong time management and organizational skills

· Strong analytical, problem-solving, and negotiation skills

Preferred Skills

· Cost containment/provider relations experience

· Experience in data and financial analysis

· Experience in processing health, dental, and vision claims or working in a support role for a claims team

· Experience with medical coding standards

· Knowledge of travel insurance claims processes, GHIP recovery/coordination of benefits, and subrogation

· Experience in handling Canadian and US medical invoices/claims

Additional Notes

• A laptop will be provided
• Our work week is Monday to Friday, 8 hours per day. The hours are flexible with start times between 8 am and 10 am. Occasional flexibility in hours is required to meet the needs of the business.