Provider Reimbursement Strategist

Zenith Insurance Company•Los Angeles, CA

3d•$59,765 - $74,707•Hybrid

About The Position

Zenith is a team of Workers' Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers' Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional. Under general direction and within Zenith guidelines, in collaboration with team members, develops and and executes negotiation strategies to achieve the most reasonable and fair reimbursement.

Requirements

High School Diploma Or equivalent Required
2+ years in position(s) where negotiation was an integral part of the job duties preferred
California Bill Review Designation.
Expert negotiation/influencing skills with demonstrated ability to influence negotiated outcomes.
Excellent written and verbal skills.
Meets all state regulatory standards regarding licensing, continuing education, and other requirements.
Action-oriented; results-oriented; with demonstrated ability to work with sense of urgency and manage multiple projects simultaneously and expeditiously.
Strong customer-service skills.

Nice To Haves

Bachelor’s Degree or equivalent combination of training/experience preferred

Responsibilities

Negotiate directly with providers for the most reasonable reimbursement of medical bills in accordance with the respective jurisdictional rules and regulations.
Use critical-thinking to make decisions affecting the outcome of payments to direct-providers.
Provides consultative recommendations to other departments on disputes, pre-servioce agreements, and settlements based upon negotiations experience and knowledge of successful strategies employed in those negotiations.
Contract directly with providers and execute legible, effective and concise negotiation agreements.
Ensure negotiations comply with regulatory and company timelines.
Document all negotiation activities and savings that occur.
Develop and preserve effective working relationships with the provider communities and billing entities that render health services to Zenith insureds.
Seek, identify and implement process improvements.
Periodically evaluate plan of action on projects and change approach when it appears that the desired outcome is not being reached.
Understand Workers' Compensation regulations to determine negotiation strategies for fair and reasonable reimbursement.
Coordinate and perform research as required (i.e. provider participation assisting in lien defense, special projects, assist in A/R research, etc.).
Applies principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
Provide problem solving regarding network information requests.
Evaluate provider trends and collaborate with various business functions to arrive at the best negotiated outcomes with direct-providers.
Review and discuss cost drivers and opportunities for further control.
Manage the overall relationship of select trading partners.
Develop direct in-person relationships with providers identified through trend analysis to impact overall medical cost.
Identify and execute cost containment strategies for all states.
Serve as a local resource of the Provider Relations department to impact provider relations for branch offices.
Work productively and harmoniously with others on a consistent basis.
Respond positively to direction and feedback on performance.
Consistently maintain professional and appropriate demeanor.
Perform other duties as assigned.