Complex Denials Consultant (Complex Claims)
About The Position
R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As a Complex Denials Consultant working with the Complex Claims team, you will represent healthcare providers in their claim disputes for workers compensation (WC), motor vehicle accident (MVA), third party liability (TPL), and veterans’ affairs (VA) claims. You will be responsible for interpreting and applying state-specific statutes, providing guidance on billing sequencing, and advising internal stakeholders of strategic ways to quickly and efficiently recover on denied claims. To thrive in this role, you must maintain a foundational understanding of applicable regulations regarding payment, coverage, lien filing practices, and other relevant topics.
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
Responsibilities
- 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.
Benefits
- annual bonus plan
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
