Senior Workers' Compensation Compliance Analyst
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AI Summary
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.
Primary 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
Qualifications
- 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.
Individual compensation will be commensurate with the candidate's experience and qualifications. Certain roles may be eligible for additional compensation, including bonuses, and merit increases. Additionally, certain roles have the opportunity to receive sales commissions that are based on the terms of the sales commission plan applicable to the role.
- Comprehensive medical, dental, vision, and life insurance coverage
- 401(k) retirement plan with employer match
- Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)
-
Paid time off (PTO) and disability leave
- Employee Assistance Program (EAP)
Equal Employment Opportunity: At Reliant, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Reliant Health Partners is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.
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