Negotiator - Remote

Overview

The Negotiator is responsible for managing appeals for underpayments and negotiating reimbursement for out-of-network claims with payers to ensure optimal payment outcomes.

In Short

• Manage appeals for underpayments and negotiate reimbursements.
• Engage with a high volume of out-of-network underpaid claims.
• Review claims against UCR rates and benchmark data.
• Contact health insurance companies to verify patient eligibility.
• Collaborate with internal teams for reimbursement strategies.
• Track and manage appeal and negotiation activities.
• Communicate effectively with payers and vendors.
• Handle escalated claims requiring advanced negotiation tactics.
• Identify trends in payer behavior for process improvements.
• Perform other duties as assigned.

Requirements

• Minimum of 3 years experience in medical billing or revenue cycle operations.
• Strong appeal and negotiation experience with out-of-network claims.
• Understanding of out-of-network claims processing methodologies.
• Familiarity with No Surprises Act and Independent Dispute Resolution processes.
• Ability to read and interpret UB-04s and CMS-1500s.
• Proficiency in claims follow-up and appeals processes.
• Strong analytical skills and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to manage multiple accounts and deadlines.
• Prior remote/work-from-home experience preferred.

Benefits

• Insurance/401k match.
• PTO/Paid holidays.
• Referral bonuses.