Provider Relations Specialist – Workers Comp

🕒 October 27

🎰 Nevada – Remote

🎰 Nevada – Remote

💵 $19 - $21 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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EK Health Services Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1998

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

EK Health Services Inc. is a comprehensive healthcare management company specializing in case management, medical bill management, and vocational services. They offer services such as discharge planning, utilization review, ergonomic evaluations, and Medicare set-aside services, ensuring excellence and efficiency in healthcare delivery. EK Health is committed to innovation and quality care, partnering with various organizations to enhance their offerings and support injured employees.

📋 Description

• Assist in a full range of provider relations and service interactions with the provider community, EK Health clients and partners • Establish and foster provider relationships • Work directly with the Bill Review team to resolve requests related to bill processing • Analyze medical bills based on claim jurisdiction, medical notes, usual and customary rates, statutory regulations, state laws and fee schedules, MPN/PPO contracts, coding guidelines, client instructions, and company policies and procedures • Explain to providers how bills were processed and the methodology used for processing and repricing • Receive provider calls, emails, and voicemails and respond within 48 hours • Monitor the bill review process from initial receipt through final payment • Review and verify medical billing codes and report improper use to Client Inquiries, Enforcer, or QA team • Work with the Bill Review team on quality assurance issues • Communicate with medical providers to obtain information needed to resolve bill-specific issues • Communicate with clients, adjusters, and providers by answering questions quickly and professionally • Participate in ongoing training • Perform other duties as assigned

🎯 Requirements

• High School Diploma required • 2+ years of experience in complex Workers' Compensation Bill Review with customer service exposure • Knowledge of medical terminology, CPT codes, and DRG • High comfort level with computers and computer programs (MS Word, MS Excel, Email) • Ability to read, analyze, and interpret technical procedures, medical reports, state laws and fee schedules • Hospital Bill Review experience a plus • CPC (Certified Professional Coding) coursework or certification a big plus • Strong Written and Oral Communication & Interpersonal Skills • Candidate must be able to sit the majority of an 8-hour day except for lunch and break times • Candidate must be able to keyboard the majority of an 8-hour day except for lunch and break times • Candidate must have manual dexterity • Candidate must be able to speak on the telephone intermittently throughout the day • Candidate must be able to read and write English fluently • Candidate must be able to provide and confirm safe home office environment • Home office must be HIPAA compliant • Requires DSL, fiber, or cable internet connection from home; 100 Mbps preferred or better • Applicants residing in California, New York, or Hawaii are not being accepted or considered

🏖️ Benefits

• Medical, Dental and Vision Insurance • 401K • Paid Time Off • Paid Holidays • Monthly internet stipend • Equipment provided

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