Member Advocate - Negotiator

Job Description

The range for this role is $66,500.00 - $90,500.00.

Actual base pay will be determined based on a successful candidate’s work location, skills/abilities, experience, and education.

Interested applicants must be willing and able to work onsite minimum 4 times per week in our Orlando, FL office.

The Mission

At Christian Care Ministry we believe that Christians can, and should, share in one another’s burdens. Through the use of Medi-Share®, a healthcare sharing ministry for Christians, we cultivate that belief. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility.

The Team

Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God and our Members to the best of our ability.

The Job

The Member Advocate Negotiator works in close partnership with the Member Bill Advocate to resolve balance bills by engaging and negotiating directly with the provider or facility that issued the bill to the member. The Negotiator applies knowledge of Medicare reimbursement rates, market benchmarks, payer-provider fee schedules to anchor and advance negotiations toward a settlement that protects the member from unexpected out-of-network charges. The role owns the full negotiation lifecycle from case assignment through settlement execution and case closure. At lower activation scenarios, the Negotiator’s significant spare capacity supports provider contracting and network analytics.

Essential Job Duties & Responsibilities

Collaboration with the Member Advocate

• Receive balance-bill cases from the Member Advocate following intake, eligibility verification, and pathway determination; review the case file for completeness before initiating negotiation
• Coordinate with the assigned Member Advocate on member context, prior provider communications, and any sensitivities that should shape negotiation tone or approach
• Provide settlement updates and projected closure timeline to the Member Advocate on a defined cadence so the Advocate can keep the member informed within SLA windows
• Hand back to the Member Advocate at settlement for member confirmation, CSAT capture, and case closure in the case management system

Negotiation Strategy & Preparation

• Research Medicare, market benchmarks, and applicable fee schedules to develop negotiation strategy and opening offers for each case
• Review provider claims for CPT/ICD coding accuracy, and billing reasonableness prior to negotiation; flag suspected coding errors or upcoding for Paralegal review when warranted
• Prepare a documented negotiation plan for each case identifying opening offer, target range, walk-away threshold, and supporting evidence

Direct Provider Engagement & Settlement

• Conduct direct payment negotiations with the provider or facility that issued the balance bill to the member, on the member’s behalf
• Manage the full negotiation lifecycle: provider outreach, counter-offer cycles, settlement execution, and case closure
• Operate within Negotiator-defined settlement authority thresholds; obtain Advocacy Team Manager authorization for settlement parameters that exceed those thresholds
• Where the case has been routed through delegation, partner with the delegated team or assume internal handling per the established hand-off criteria; ensure no duplicative provider outreach

Documentation & Case Management

• Document all negotiation activity, communications, and settlement terms in the case management system in real time and to audit-ready standards
• Maintain accurate, current case status so that the Member Advocate, Manager, and any delegated vendor can rely on a single source of truth for the case

Cross-Team Coordination & Escalation

• Collaborate with paralegals on legal case file preparation for complex, high-dollar, or multi-party negotiations
• Escalate unresolvable cases to the Advocacy Team Manager and coordinate transition to alternative dispute resolution, third-party arbitration, or external legal counsel as authorized
• Coordinate with Claims, Network Management, or Provider Relations when a negotiation reveals a contracting, configuration, or claim-processing issue requiring upstream correction

Pattern Identification & Continuous Improvement

• Identify recurring provider billing patterns and report systemic issues to the Advocacy Team Manager for network-level correction
• Maintain current knowledge of applicable state balance billing law and the organization’s sharing program guidelines as they affect provider negotiation strategy
• Contribute lessons learned and successful negotiation tactics back to the team’s playbook and training materials
• Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs
• All other duties as assigned

Essential Skills & Abilities

• Advanced understanding of Program Guidelines to all member/provider issues
• Strong written and verbal communication skill – able to explain settlement positions clearly to providers, members, and internal stakeholders
• Disciplined documentation habits and proficiency with case management systems
• Proficiency with CPT/ICD coding and Medicare fee schedule analysis
• Understanding of managed care contracts
• Negotiation skill – able to negotiate directly with hospital, facilities, and physician group medical billing office personnel at all levels
• Ability to read, interpret and apply vendor and provider contracts
• Knowledge and skill applying applicable state balance billing laws with the organizations policies, guidelines, and practices
• Ability to apply common sense understanding to carry out instruction furnished in written, oral or diagram form; deal with problems involving several variables in standardized situations
• Understanding of multi-band or multi-tier provider network program structures and delegated payment-integrity operations
• Proficiency with Microsoft Office Suite (Excel, Word, Outlook, Teams, PowerPoint)

Core Competencies/Demonstrable Behaviors

• Manages Conflict – handles conflict situations effectively.
• Drives Results – consistently achieves results, even under tough circumstances and tight deadlines.
• Courage – ability to have tough conversations and deliver accurate advice and decisions regardless of risk or potential criticism
• Member First – exhibits full commitment to serving members and/or clients by prioritizing their needs first in alignment with our program’s purpose.  This commitment is demonstrated through understanding of the program(s), provided through quality and timely service while exercising empathy in every interaction.  Every CCM employee shares responsibility to steward resources faithfully, removing barriers to understanding, and creating accessible, connected, and Christ-centered experiences.
• Humble – demonstrates Christ-Centered humility by honoring others, accepting feedback, and prioritizing collective success over individual recognition
• Hungry – exhibits initiative, perseverance, and commitment to serving God through excellence. Demonstrates passion for personal and organizational growth while diligently advancing the mission of Christian Care Ministry
• Smart – shows relational and emotional intelligence, communicates effectively, collaborates harmoniously, and reads social cues with grace and discernment

Education and/or Experience

• Bachelor’s degree in healthcare administration, Business, or Finance, required; combination of education or equivalent experience may satisfy this requirement
• 3+ years of experience in healthcare payment negotiation, provider contracting, or provider relations, required
• Demonstrated experience negotiating directly with hospitals, facilities, or physicians’ groups required
• Experiencing operating within or alongside a delegated payment-integrity / provider dispute vendor relationship a strong plus
• Familiarity with healthcare sharing models and shared-eligibility determinations a plus
• Prior experience handling third-part arbitration filings and working with managed care contracts preferred

Supervisory Responsibilities

• This job has no supervisory responsibilities

Travel

• Minimal travel may be required for provider meetings or training events

Incentives & Benefits

We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.

For full-time employees working 30 hours or more, some of our benefits include, but are not limited to:

• 100% paid Medical for employees/99% for family
• Generous employer Health Savings Account (HSA) contributions
• Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
• 6 weeks of paid parental leave (for both mom and dad)
• Dental - two plans to choose from
• Vision
• Short-term Disability
• Accident, Critical Illness, Hospital Indemnity
• 401(k) – up to 4% match on ROTH or Traditional contributions
• Generous paid-time off and 11 paid holidays
• Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
• Employee Assistance Program including no cost, in-person mental health visits and employee discounts
• Monetary Anniversary Awards Program
• Monetary Birthday Awards
• Tuition Reimbursement Program

Minimum Age Requirement: Due to the nature of the responsibilities associated with this position—including independent decision-making, access to confidential information, and potential exposure to regulated environments—candidates must be at least 18 years of age at the time of hire. This requirement is in accordance with applicable federal and state labor laws and is intended to ensure compliance with workplace safety and legal standards.