Workers' Compensation Appeal Specialist

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

📋 Description

• Oversee a caseload of post-payment Workers’ Compensation invoices, managing state balance billing and disputes regarding usual and customary rates (UCR).

• Engage with providers to elucidate payment methodologies, settle disputes, and negotiate reductions on contested or atypical bills.

• Liaise with clients to coordinate and probe into case or appeal details.

• Provide education to providers on Workers’ Compensation billing, reimbursement policies, and regulatory obligations.

• Meticulously document all communications with providers, details of bills, payment proposals, counteroffers, and conclusive resolutions.

• Comply with state-specific regulations and adhere to HIPAA confidentiality guidelines.

• Uphold productivity and quality benchmarks while resolving bills within the designated state timelines.

• Follow client-specific protocols and internal Reliant procedures, including adherence to scripting and documentation standards.

• Keep up-to-date with changes in Workers’ Compensation regulations, fee schedules, and payment policies across various states.

• Collaborate effectively as part of a team.

• Assist with special projects and undertake other assigned responsibilities.

⛳️ Requirements

• 2–3 years of pertinent experience in Workers’ Compensation billing, medical billing, medical coding, or insurance negotiations.

• Strong comprehension of Workers’ Compensation reimbursement methods, state regulations, and provider billing practices.

• Proficient in negotiating medical bill payments or adjustments with providers.

• Ability to work collaboratively with a diverse range of individuals, both internally and externally.

• Familiarity with claims processing systems and communications with providers.

• Exceptional communication, negotiation, and organizational abilities.

• Requires strong organizational skills, effective communication, discretion, ethical behavior, decision-making ability, and technical proficiency.

🏝️ Benefits

• Comprehensive medical, dental, vision, and life insurance coverage.

• 401(k) retirement plan with employer matching.

• Health Savings Account (HSA) and Flexible Spending Accounts (FSAs).

• Paid time off (PTO) and disability leave.

• Employee Assistance Program (EAP).