Communication_and_Personality_in_Negotiation

Communication and Personality in Negotiation A negotiation is a method involving two groups in talks to find an amicable resolution around a difficult issue. The negotiation I took place in happened to resolve an ongoing problem with an insurance company. The insurance company failed to reimburse the organization for dialysis services rendered to patients according to the rates specified in the insurances federal benefits summary plan description for facilities considered an out-of-network provider. This dissertation will evaluate the roles of communication and personality in negotiation and how they contributed to or detracted from the negotiation. When communicating with others it is important to identify each side participating in the negotiation process has a personality. Acknowledging the differences in individual personalities and the ability to determine the appropriate personality to use during the negotiation process to achieve the best outcome for everyone is important. When dealing with individuals on an ongoing basis it is helpful because one has an opportunity to become familiar with their opponent enough to know the type of personality he or she is dealing. The dialysis company rendered dialysis services to a number of patients’ and billed his and her insurance carrier only to receive payments based on a contracted rate, which was agreed upon by both parties for the PPO, Indemnity, and POS products instead of at 65% of full billed charges. As a representative of the organizations billing department the appropriate number of appeals were sent to the insurance company only to receive the same response stating the claims were processed correctly and no additional payment would be issued. It was later brought to the organizations attention that several patients’ accounts were underpaid and appealed with no additional payments issued to the sum of approximately $500K. The organization typically uses negotiations to come to an agreement on contract rates, short-term payment agreements, and reimbursement of out-of-network reimbursements for services rendered in regard to a life sustaining condition. The director of billing decided to attempt using the negotiation process with the insurance carrier before resorting to legal actions. Setting up a conference call between the director, manager, supervisor, and representative of the organization’s billing department, and the claims director, manager of the insurance company to discuss the processing of the previous underpaid claims. During the phone communications discussions transpired back and forth expressing the issue. The communication process also involved an explanation to the insurance carrier informing them the only way a contracted rate can be used is there must be a signed contract on file for each product line. Out-of-network claims should not be paid according to the insurance companies contracted rates whenever possible. As the billing representative assigned to work the insurance plan, I was responsible to compile data to include patients’ id numbers, dates-of-services, charges, receipts, and balances due for the conference call. “It is widely assumed that successful negotiators are planful, attentive, organized, and have high aspirations the very characteristics one might expect from a person high in the personality trait of conscientiousness” (Lewicki, Saunders, Barry, 2005, p. 397). During the negotiations the billing manager was direct during the discussion process although at times it caused the insurance representative to become defensive. “A greater risk for extroverted and agreeable negotiators because of their greater focus on the maintenance of social relations. Negotiators with a high degree of motivation to do well overcame the liability of certain personality traits in negotiations” (Lewicki, Saunders, Barry, 2005, p. 397). When conducting negotiations over the phone it is vital for all parties to watch the tone in his or her voice to prevent offending the other party. The billing manager’s extroversion personality hindered the discussions by offending the insurance representative and causing the discussion to be sidetracked to clear up any misunderstandings perceived by the opposing side. “The activity of having or managing a conflict occurs through communication. More specifically, communication undergirds the setting and reframing of goals; the defining and narrowing of conflict issues; the developing of relationships between disputants and among constituents; the selecting and implementing of strategies and tactics; the generating, attacking, and defending of alternative solutions; and the reaching and confirming of agreements” (Putnam and Poole, p. 550). Negotiations are simply the process of communication and making sure each side identifies a way to agree to a solution which everyone wins in the end. Working with the insurance carrier for two hours it was determined the claims were processed according to a contract for the Federal policies. The organizations contracts department sat in on the call, and it was determined the contract was no longer valid; therefore, the insurance company updated their systems and the claims representative would review the previously processed claims for additional payment to be received within 30 days from the call. Both parties acknowledged their part in the miscommunication in regard to the contract. The insurance company assured the billing manager the situation would be resolved and would not happen in the future. A suggestion was made to have every contract reviewed on both sides to ensure there is no other contract’s that should be terminated but are still effective in the establishments systems. Resolving this issue with the insurance carrier within a timely manner assists helps the organization to decrease the days sales outstanding (DSO). “Days sales outstanding are a calculation used by a company to estimate their average collection period. A low number of days indicate the company collects its outstanding receivables quickly” (http://encyclopedia.thefreedictionary.com). Conclusion In conclusion, decreasing conflict during the negotiation process is imperative; participants must work together to a find solution beneficial to all. Establishments negotiating claim payment rates with an insurance company is a winning solution for organization rendering life sustaining services to individuals with end stage renal disease. The contracting department typically negotiates contract pricing with insurance carries; however, when there is a facility considered out-of-network the negotiator is the billing director, billing manager, and billing representative. A number of people may start the negotiation process with their own issues on his or her mind. Whereas, organizations go into the negotiation process only seeking their own organizational success. An establishment can maintain success in the future; discussions are an important device to retain profitable. Effective negotiations depend on the communiqué among the participants, and bargaining’s affected by the temperament of everyone involved. References Days Sales Outstanding, Retrieved September 19, 2011 from http://encyclopedia.thefreedictionary.com/Days+Sales+Outstanding Putnam and Poole, (1987), The Nature of Communication in Negotiations p. 550. Lewicki, Saunders, Barry, (2005), Negotiation, fifth edition – The “Big Five” Personality Factors (p. 397).