REVCO SOLUTIONS INC - Negotiator

REVCO SOLUTIONS INC

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

· 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