REVCO SOLUTIONS INC - Negotiator

REVCO SOLUTIONS INC - Negotiator In order to use this site, it is necessary to enable JavaScript. Here are the instructions how to enable JavaScript in your web browser . All Jobs > Negotiator REVCO SOLUTIONS INC Apply Negotiator Fully Remote Apply Description OUR COMPANY : Revco Solutions Inc provides best-in-class Revenue Cycle management to Hospital and Physician Service clients. What We Offer: Insurance/401k match PTO/Paid holidays Referral bonuses POSITION DESCRIPTION : The Negotiator is responsible for managing appeals for underpayments and negotiating reimbursement for out-of-network claims with payers to ensure optimal payment outcomes. MAJOR AREAS OF RESPONSIBILITY : · Engage and manage a high volume of out-of-network underpaid claims with payers and third-party pricing vendors to secure favorable reimbursement rates via payor portal, phone and email · Review and analyze claims against usual, customary, and reasonable (UCR) rates and benchmark data to support maximum reimbursement · Responsible for contacting health insurance companies to verify patient eligibility, coverage, and benefit details, ensuring accuracy of information. · Collaborate with internal teams to determine appropriate reimbursement expectations and negotiation strategies · Track and manage all appeal and negotiation activities, including payer communications, deadlines, and outcomes · Maintain timely, clear and accurate detailed documentation of all negotiations and claim activity · Communicate effectively with payers, vendors, and internal stakeholders to drive timely resolution · Handle escalated or complex claims requiring advanced appeal and negotiation tactics · Identify trends in payer behavior and reimbursement patterns to support process improvements · Support appeals and additional follow-up as needed to maximize reimbursement · Perform other duties as assigned Requirements · Minimum of 3 years of experience in medical billing, insurance follow-up, provider or payor negotiations or revenue cycle operations · Strong appeal and negotiation experience, preferably with out-of-network claims working with payors, pricing vendors and payer appeal and negotiation processes · Strong understanding of out-of-network claims processing and reimbursement methodologies · Familiarity with No Surprises Act (NSA) and Independent Dispute Resolution (IDR) processes preferred · Ability to read and interpret UB-04s, CMS-1500s, and EOBs, Experience working with CPT/HCPCS/Revenue codes · Proficiency in claims follow-up, payment posting, and appeals processes · Strong analytical skills with attention to detail · Excellent communication and interpersonal skills · Ability to manage multiple accounts, deadlines, and priorities effectively · Ability to work independently and stay organized in a remote environment · Experience with healthcare systems, payor portals and billing platforms · Strategic negotiation and problem-solving · Strong organizational and time management skills · Ability to work independently and collaboratively, Prior remote/work-from-home experience strongly preferred · Professionalism and confidentiality in handling sensitive information · Proficiency in Microsoft Office Suite and Teams · High School Diploma or equivalent required Salary Description $20-24/hr. Apply View All Jobs Powered by Payroll & HR Software