Senior Workers' Compensation Compliance Analyst

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Reliant Health Partners

Site WebLinkedInTous les Emplois

11 - 50 employés

⚕️ Assurance santé

🤝 B2B

Healthcare Insurance • B2B

Reliant Health Partners est une entreprise axée sur les données qui se consacre à la maîtrise des coûts de santé en offrant des solutions de réévaluation des réclamations médicales et des prix de marché équitables pour les régimes de santé auto-financés. Collaborant avec des TPAs, des courtiers et des organismes de révision des factures, Reliant fournit des services de remplacement de plan à accès ouvert, de réévaluation hors réseau et en cas de sinistre, une gestion complète des appels, et un traitement rapide des réclamations grâce à des analyses propriétaires pour maximiser les économies tout en minimisant les litiges avec les prestataires et le bruit administratif.

Description

• 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

🎯 Exigences

• 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.

🏖️ Avantages

• 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)