Workers' Compensation Appeal Specialist

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $60k - $65k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Reliant Health Partners

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Reliant Health Partners is a data-driven healthcare cost-containment firm that provides medical-claims repricing and Fair Market Pricing solutions for self-funded health plans. Working with TPAs, brokers, and bill-review organizations, Reliant delivers open-access plan replacement, out-of-network and casualty repricing, end-to-end appeals management, and rapid claim turnaround using proprietary analytics to maximize savings while minimizing provider dispute and administrative noise.

📋 Description

• Manage a caseload of post-payment Workers’ Compensation bills, including state balance billing and usual and customary rate (UCR) disputes. • Conduct provider outreach to explain payment methodologies, resolve disputes, and negotiate reductions on appealed or outlier bills. • Communicate with clients to coordinate and investigate case or appeal information. • Educate providers on Workers’ Compensation billing, reimbursement policies, and regulatory requirements. • Thoroughly document provider communications, bill details, payment offers, counteroffers, and final resolutions. • Adhere to state-specific compliance standards and HIPAA confidentiality requirements. • Maintain productivity and quality standards and resolve bills within state timelines. • Follow client-specific protocols and internal Reliant procedures, including scripting and documentation guidelines. • Stay current on Workers’ Compensation regulatory changes, fee schedules, and payment policies across multiple states. • Work effectively as a team member. • Support special projects and perform additional assigned duties.

🎯 Requirements

• 2–3 years of relevant experience in Workers’ Compensation bills, medical billing, medical coding, or insurance negotiations. • Strong understanding of Workers’ Compensation reimbursement methodologies, state regulations, and provider billing practices. • Experience negotiating medical bill payments or adjustments with providers. • Ability to collaborate with a variety of individuals both internally and externally. • Familiarity with claims processing systems and provider communications. • Excellent communication, negotiation, and organizational skills. • Requires organizational skills, communication proficiency, discretion, ethical conduct, decision making, and technical skills.

🏖️ Benefits

• 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)