Provider Relations Specialist – Workers Comp

This is a fully remote position, open to applicants in Nevada.

📋 Description

• Support a comprehensive array of provider relations and service interactions with the provider community, EK Health clients, and partners.

• Develop and nurture relationships with providers.

• Collaborate directly with the Bill Review team to address requests associated with bill processing.

• Evaluate medical bills by considering claim jurisdiction, medical notes, customary rates, statutory regulations, state laws, fee schedules, MPN/PPO contracts, coding guidelines, client directives, and company policies and procedures.

• Clarify to providers the processes involved in bill processing and the methodologies applied for processing and repricing.

• Handle provider communications via calls, emails, and voicemails, ensuring responses are made within 48 hours.

• Oversee the bill review process from initial receipt until final payment.

• Validate and confirm medical billing codes while reporting any improper usage to the Client Inquiries, Enforcer, or QA team.

• Collaborate with the Bill Review team on quality assurance matters.

• Engage with medical providers to gather necessary information for resolving bill-specific issues.

• Interact with clients, adjusters, and providers by promptly and professionally addressing inquiries.

• Participate in continuous training sessions.

• Carry out additional duties as assigned.

⛳️ Requirements

• High School Diploma is mandatory.

• A minimum of 2 years of experience in complex Workers' Compensation Bill Review along with customer service exposure.

• Familiarity with medical terminology, CPT codes, and DRG.

• Strong proficiency with computers and software programs (MS Word, MS Excel, Email).

• Capability to read, analyze, and interpret technical procedures, medical reports, state laws, and fee schedules.

• Experience in Hospital Bill Review is advantageous.

• Completion of CPC (Certified Professional Coding) coursework or certification is highly preferred.

• Excellent written and verbal communication skills as well as strong interpersonal abilities.

• Candidates must be able to sit for the majority of an 8-hour workday, excluding lunch and break times.

• Candidates must be able to type for the majority of an 8-hour workday, excluding lunch and break times.

• Manual dexterity is required.

• Candidates must be able to engage in telephone conversations intermittently throughout the day.

• Fluency in reading and writing English is essential.

• Candidates must ensure a safe home office environment.

• The home office must comply with HIPAA regulations.

• A DSL, fiber, or cable internet connection from home is required; 100 Mbps or better is preferred.

• Applications from residents of California, New York, or Hawaii will not be accepted or considered.

🏝️ Benefits

• Medical, Dental, and Vision Insurance.

• 401K plan.

• Paid Time Off.

• Paid Holidays.

• Monthly internet stipend.

• Equipment provided.