Senior Workers' Compensation Compliance Analyst

🕒 Maio 20

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Reliant Health Partners

SiteLinkedInTodas as Vagas

11 - 50 funcionários

⚕️ Seguro de Saúde

🤝 B2B

Healthcare Insurance • B2B

A Reliant Health Partners é uma empresa movida por dados que atua na contenção de custos na área de saúde, oferecendo soluções de reprecificação de sinistros médicos e precificação de mercado justo para planos de saúde autofinanciados. Trabalhando com Administradoras de Planos de Saúde (TPAs), corretores e organizações de revisão de contas médicas, a Reliant oferece substituição de planos de acesso aberto, reprecificação de fora da rede e acidentária, gestão completa de apelações e rápida conclusão de sinistros, utilizando análises exclusivas para maximizar economias enquanto minimiza disputas com fornecedores e ruído administrativo.

Descrição

• Assist with reviewing state fee schedule rules, guidelines, regulations, and/or statutes for changes or compliance risks with reimbursement • Draft second level reconsideration letters • Assist with drafting and responding to state disputes • Determine if the second level reconsideration request requires a medical coder or clinician for audit • Work with the Director of Policy and Strategy Operations or the equivalent role to assist in implementing system changes for risk mitigation in Workers’ Compensation fee schedules or gap logic • Provide consultation internally or externally where appropriate • Provide internal training where required for compliance • Assist in the development of compliance processes and procedures • Partner with other business units to ensure compliance with implementing, adopting, or expanding on the rules and/or regulations, including but not limited to policies, procedures, and contracts • Responsible for handling high level appeals – either based on the client or dollar threshold • Establish special reimbursement policies for identified TIN’s • Other duties as assigned or requested • Responsible for handling negotiation with attorneys for state disputes

🎯 Requisitos

• 5+ Years with current or former healthcare fraud, compliance, and/or legal experience. • 3+ Years working with various medical reimbursement methodologies. • 3+ Years understanding medical coding and/or billing patterns and/or practices. • Knowledge of limited liability in property and casualty insurance • Basic understanding of treatment parameters and coding • Strong research skills • Comfort with reading fee schedule rules, regulations, and statutes • Strong oral and written communication • Good judgment, initiative, and discretion in confidential or sensitive matters • Self-starter with the ability to independently work urgently approaching deadlines and in a team • Creative thinking and effective risk mitigation abilities with strong decision-making skills • Strong analytical abilities • Strong computer skills and experience with relevant software • Excellent communication and presentation • Strong critical thinking, analytical, and problem-solving • Good interpersonal and organizational • Strong written and oral communication skills. • Intermediate or Advanced knowledge of Excel, PowerPoint, and Word.

🏖️ Benefícios

• Comprehensive medical, dental, vision, and life insurance coverage • 401(k) retirement plan with employer match • Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) • Paid time off (PTO) and disability leave • Employee Assistance Program (EAP)