Negotiator for Out-of-Network Claims

Job Summary

A company is looking for a Negotiator responsible for managing appeals for underpayments and negotiating reimbursement for out-of-network claims.

Key Responsibilities

• Manage a high volume of out-of-network underpaid claims with payers to secure favorable reimbursement rates
• Review and analyze claims against UCR rates and benchmark data to support maximum reimbursement
• Track and manage all appeal and negotiation activities, ensuring timely resolution and documentation

Required Qualifications

• Minimum of 3 years of experience in medical billing, insurance follow-up, or revenue cycle operations
• Strong appeal and negotiation experience, particularly with out-of-network claims
• Understanding of out-of-network claims processing and reimbursement methodologies
• High School Diploma or equivalent required
• Proficiency in Microsoft Office Suite and Teams