Complex Denials Consultant – Complex Claims

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $90k - $112.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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R1 RCM

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

⚕️ Healthcare Insurance

☁️ SaaS

💸 Finance

💰 Private Equity Round on 2024-07

Healthcare Insurance • SaaS • Finance

R1 RCM is a leading provider of revenue cycle management solutions for the healthcare industry. With an emphasis on maximizing financial performance and optimizing patient care, R1 offers a comprehensive platform that integrates data analytics, intelligent technologies, and deep expertise in revenue cycle management. The company assists healthcare providers—ranging from hospitals and health systems to physician and specialty care practices—in capturing revenue opportunities, improving payer and patient cash flows, and ensuring compliance with government regulations. R1 is committed to driving cost reductions and revenue improvements while enhancing the patient experience. Their suite of services includes revenue recovery, clinical integrity, and regulatory navigation, making them a trusted partner for many top healthcare providers.

📋 Description

• Oversee and assist in the pursuit of reimbursement of denied WC, MVA, Other TPL, and VA claims • Draft complex appeals, correspondence, and other documents as appropriate • Understand and skillfully apply state-specific statutes related to WC claims • Oversee lien practices and ensure that they comply with applicable state laws, Patient Protection Acts, and evolving case law • Assist with the training of recovery staff team members and provide necessary feedback as requested by management • Coordinate with external counsel on strategy, pleadings, settlement posture, and cost-benefit analysis • Develop new and innovative legal and procedural arguments and tools for team usage • Foster professional, collaborative relationships to facilitate favorable resolutions

🎯 Requirements

• Law degree from an accredited college or university • Barred in one state or must be bar-eligible within 6 months of graduation • Legal experience with emphasis on one or more of the following: Healthcare law, Insurance defense or plaintiff personal injury, Hospital or health system legal affairs, Complex reimbursement or lien litigation • Strong working knowledge of: MVA laws and insurance structures, Hospital lien statutes and enforcement, Regulatory compliance in healthcare reimbursement

🏖️ Benefits

• Competitive benefits package