Provider Relations Specialist - Workers Comp - REMOTE!

EK Health Services Inc.•Sparks, NV

11d•$19 - $21•Remote

About The Position

The Provider Relations Specialist assists with provider relations and service interactions involving the provider community, EK Health clients, and partners. Under the direction of the Bill Review Team Lead, this position establishes and fosters relationships and works with the Bill Review team to resolve requests related to bill processing. This is a full-time, non-exempt remote position, Monday through Friday, with an 8-hour workday scheduled from 8:00 a.m. to 4:30 p.m. PST. Applicants residing in California, New York, or Hawaii are not being considered at this time.

Requirements

High school diploma.
At least 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 programs such as MS Word, MS Excel, and email.
Ability to read, analyze, and interpret technical procedures, medical reports, state laws, and fee schedules.
Strong written and oral communication and interpersonal skills.
Ability to sit and keyboard for most of an 8-hour day, except during lunch and breaks; manual dexterity; ability to speak on the telephone intermittently; fluency in reading and writing English; and ability to provide and confirm a safe home office environment.
Home office must be HIPAA compliant.
DSL, fiber, or cable home internet connection required; 100 Mbps or better preferred.

Nice To Haves

Hospital Bill Review experience.
CPC (Certified Professional Coding) coursework or certification.

Responsibilities

Analyze medical bills using claim jurisdiction, medical notes, usual and customary rates, statutory regulations, state laws and fee schedules, available MPN/PPO contracts, coding guidelines, client instructions, and company policies and procedures.
Understand how bills were processed and explain the processing and repricing methodology to providers.
Receive provider calls, emails, and voicemails and respond within 48 hours.
Monitor bills from initial receipt through final payment.
Review and verify the correct use of medical billing codes and report detected improper use to the Client Inquiries, Enforcer, or QA team.
Work with the Bill Review team on quality assurance issues identified for review and handling.
Communicate with medical providers to obtain information needed to resolve bill-specific issues.
Communicate with clients, adjusters, and providers, answering questions promptly and professionally while providing customer service.
Participate in ongoing training to enhance job skills and knowledge.
Perform other duties as assigned.