Senior Workers' Compensation Compliance Analyst

Reliant

9d•$65,000 - $70,000

About The Position

Reliant Health Partners is an innovative medical claims repricing service provider, helping employers achieve maximum health plan savings with minimum noise. We tailor our services to each client’s needs, providing everything from individual specialty claims repricing, to full plan replacement as a high-performance, open-access network alternative. As a Senior Workers’ Compensation Compliance Analyst, you will play a critical role in expanding the boundaries of the healthcare industry through innovations that intersect data and technology and amplifies human intelligence to result in better outcomes. We need people like you to join in our commitment to drive pure exponential value for our clients and partners.

Requirements

5+ Years with current or former healthcare fraud, compliance, and/or legal experience.
3+ Years working with various medical reimbursement methodologies.
3+ Years understanding medical coding and/or billing patterns and/or practices.
Knowledge of limited liability in property and casualty insurance
Basic understanding of treatment parameters and coding
Strong research skills
Comfort with reading fee schedule rules, regulations, and statutes
Strong oral and written communication
Good judgment, initiative, and discretion in confidential or sensitive matters
Self-starter with the ability to independently work urgently approaching deadlines and in a team
Creative thinking and effective risk mitigation abilities with strong decision-making skills
Strong analytical abilities
Strong computer skills and experience with relevant software
Excellent communication and presentation
Strong critical thinking, analytical, and problem-solving
Good interpersonal and organizational
Strong written and oral communication skills.
Intermediate or Advanced knowledge of Excel, PowerPoint, and Word.

Responsibilities

Assist with reviewing state fee schedule rules, guidelines, regulations, and/or statutes for changes or compliance risks with reimbursement
Draft second level reconsideration letters
Assist with drafting and responding to state disputes
Determine if the second level reconsideration request requires a medical coder or clinician for audit
Work with the Director of Policy and Strategy Operations or the equivalent role to assist in implementing system changes for risk mitigation in Workers’ Compensation fee schedules or gap logic
Provide consultation internally or externally where appropriate
Provide internal training where required for compliance
Assist in the development of compliance processes and procedures
Partner with other business units to ensure compliance with implementing, adopting, or expanding on the rules and/or regulations, including but not limited to policies, procedures, and contracts
Responsible for handling high level appeals – either based on the client or dollar threshold
Establish special reimbursement policies for identified TIN’s
Other duties as assigned or requested
Responsible for handling negotiation with attorneys for state disputes