Senior Workers' Compensation Compliance Analyst

🕒 vor 20 Tagen

Jetzt Bewerben

Ähnliche Remote-Jobs finden

E-Mails für Remote-Jobs erhalten

📊 Überprüfen Sie Ihre Lebenslauf-Bewertung für diese Stelle

Verbessern Sie Ihre Chancen auf ein Vorstellungsgespräch, indem Sie Ihre Lebenslauf-Bewertung vor der Bewerbung überprüfen.

Lebenslauf hochladen

Reliant Health Partners

WebsiteLinkedInAlle Stellen

11 - 50 Mitarbeiter

⚕️ Krankenversicherung

🤝 B2B

Healthcare Insurance • B2B

Reliant Health Partners ist ein datengesteuertes Unternehmen zur Eindämmung von Gesundheitskosten, das Lösungen zur Neubepreisung von medizinischen Ansprüchen und Fair-Market-Pricing-Lösungen für eigenfinanzierte Gesundheitspläne anbietet. In Zusammenarbeit mit TPAs, Maklern und Rechnungsprüfungsorganisationen bietet Reliant einen offenen Zugang zum Ersatz von Plänen, Neubepreisung von Leistungen außerhalb des Netzwerks und bei Unfällen, vollständige Bearbeitung von Einsprüchen und schnelle Anspruchsabwicklung unter Verwendung proprietärer Analysen, um Einsparungen zu maximieren und gleichzeitig Streitigkeiten mit Anbietern und Verwaltungsaufwand zu minimieren.

Beschreibung

• 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

🎯 Anforderungen

• 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.

🏖️ Vorteile

• 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)