ResponsibilitiesManage and supervise the Balance Billing/Fee Negotiation Unit in eliminating and reducing any out of pocket expenses for the membership in a timely and efficient mannerResolve staff issues and audit completed files for compliance and accuracy and weekly timesheetNegotiate full settlements for hospital and medical claims for members who are in networkTroubleshoot difficult cases and work with attorneys on settling judgement against members for hospital and medical claims; prevent and/or stop income garnishmentsWork with collection agencies to resolve outstanding accounts on the members’ behalfInvestigate Coordination of Benefits (COB) to verify that the Fund is the primary carrier or not and verify member’s eligibilityDevelop relationships with out of network providers to ensure finalize out of network arrangements timely and manage and resolve any servicing and claims related issues resulting from Single Case Agreements that have been negotiatedResponsible for tracking and trending out of network activity, cost savings and making recommendations on potential contracting opportunities to support provider network adequacyIdentify opportunities to find potential savings with challenging /unsuccessful providers and develop and maintain all Balance Billing Unit Reporting and support high level appeals including first, second and third levelsCoordinate communication and workflows across departments including Claims, Staff Claims, Member Services, and OutreachPerform additional duties and projects as assigned by managementQualificationsBachelor’s degree or equivalent years of work experience requiredMinimum six (6) years relevant healthcare experience in balance billing or claims; to include three (3) years of supervisory experience requiredProficient skill level in Microsoft Office suiteStrong knowledge in CPT, ICD-10 professional and diagnostic DRG codesExcellent problem solving and analytical skillsAbility to plan, coordinate, and direct staff duties in various professional, technical and clerical functions