[Remote] Appeals Specialist - Workers' Compensation
Note: The job is a remote job and is open to candidates in USA. Reliant Health Partners is an innovative medical claims repricing service provider, helping employers achieve maximum health plan savings with minimum noise. As an Appeals Specialist – Workers’ Compensation, you will play a critical role in resolving post-payment disputes related to Workers’ Compensation bills, conducting provider outreach, negotiating disputed charges, and ensuring compliance with state-specific regulations.
Responsibilities
- Manage a caseload of post-payment Workers’ Compensation bills, including those related to state balance billing and usual and customary rate (UCR) disputes
- Conduct proactive outreach to medical providers to explain payment methodologies, resolve disputes, and negotiate reductions on appealed or outlier bills
- Communicate effectively and professionally with clients to coordinate and investigate information as it relates to the case/appeal
- Educate providers on Workers’ Compensation billing and reimbursement policies and regulatory requirements
- Document all provider communications thoroughly, including contact information, bill details, proposed and counter-offered payment rates, and final resolution
- Adhere to state-specific compliance standards and confidentiality requirements, including HIPAA
- Maintain productivity and quality standards, ensuring timely resolution of bills in accordance with state timelines
- Follow client-specific protocols and internal Reliant procedures, including scripting and documentation guidelines
- Stay current on Workers’ Compensation regulatory changes, fee schedules, and payment policies across multiple states
- Works as an effective team member
- Support special projects and perform additional duties as assigned
Skills
- 2–3 years of relevant experience in Workers' Compensation bills, medical billing, medical coding, or insurance negotiations
- Strong understanding of Workers' Compensation reimbursement methodologies, state regulations, and provider billing practices
- Experience negotiating medical bill payments or adjustments with providers
- Ability to collaborate with a variety of individuals both internally and externally
- Familiarity with claims processing systems and provider communications
- Excellent communication, negotiation, and organizational skills
- Requires organizational skills, communication proficiency, discretion, ethical conduct, decision making, technical skills
Benefits
- 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)
Company Overview
- Reliant Health Partners is a medical cost containment and specialty bill review company. It was founded in 2010, and is headquartered in Collierville, Tennessee, USA, with a workforce of 11-50 employees. Its website is http://relianthp.com/.
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