Job description
Overview
We are looking specifically for an Out-of-Network Negotiator who eats, sleeps, and breathes the No Surprises Act for Surgery specialty.
The Role:
You will be a point person for all out-of-network revenue. Your day-to-day will involve high-level negotiations with insurance companies, managing the "No Surprises" negotiation process, and winning appeals through meticulous clinical reviews.
What You Must Bring:
- Negotiation Grit: You know how to talk to payers and get claims paid at higher than "median" rates.
- NSA Expertise: You understand how to handle out-of-network claims without triggering balance-billing violations.
- Detail Mastery: You can review complex medical records and terminology to find the "hook" for a successful appeal.
- Team Mindset: You are an independent contractor who loves working with a remote team of other experts.
Technical Skills:
Professional experience with OON appeals, negotiation portals, and high-level medical revenue cycle management.
Duties
- Process and record incoming denials to review and appeal.
- Manage accounts receivable aging reports to negotiate appeals for no surprise billing with insurance company for review.
- Review patient accounts for discrepancies and resolve issues as needed.
- Collaborate with the medical billing team to ensure proper coding of services using DRG, CPT, ICD-9, and ICD-10 coding systems.
Requirements
- Proven experience in medical billing, collections, or a similar role within a medical office setting.
- Strong knowledge of medical terminology and coding practices (DRG, CPT, ICD-9, ICD-10).
- Familiarity with EMR and EHR systems is highly desirable.
- Excellent attention to detail with strong organizational skills.
- Ability to work independently while managing multiple tasks effectively.
- Strong communication skills for interacting with patients and team members.
- Availability to work a day shift, Monday through Friday.
Compensation & Hiring Process:
- Pay: Starting from $15.00 per hour.
- Job Type: Part-time, Independent contractor.
- Trial Period: A two-week paid trial period will be conducted to assess knowledge and skills.
Job Types: Part-time, Contract
Pay: From $15.00 per hour
Benefits:
- Flexible schedule
Application Question(s):
- Walk me through your system for tracking the 30-day 'Open Negotiation' period and the 4-day 'IDR Submission' window. What do you do if a payer doesn't respond to the initial negotiation notice?
- Explain the difference between a 'Qualified Payment Amount' (QPA) and the 'Offer' we should submit. If a surgeon has a complex case, what specific non-QPA factors would you include in the narrative to justify a higher payment?
Work Location: Remote