Provider Relations Specialist - Workers Comp - REMOTE

EK Health Services Inc.; Sparks (NV); À distance; USD 26 000 - 29 000; Plein temps

Avantages offerts par ce poste

Medical, Dental and Vision Insurance

401K

Paid Time Off

Paid Holidays

Monthly internet stipend

Equipment provided

Résumé du poste

EK Health Services Inc. is seeking a Provider Relations Specialist to assist in comprehensive provider relations and service interactions with EK Health clients and partners. The role collaborates with the Bill Review team to resolve bill processing requests.

Responsibilities include analyzing medical bills, communicating methodologies to providers, and ensuring timely responses to inquiries while upholding high standards of customer service and compliance.

Qualifications

• High School Diploma required.
• CPC coursework or certification is a big plus.
• Knowledge of medical terminology, CPT codes, and DRG.

Responsabilités

• Analyze medical bills based on jurisdiction, UCR, regulations, contracts and guidelines.
• Explain to providers how bills are processed and re-priced.
• Receive provider inquiries and respond within 48 hours.
• Monitor bill review through to final payment.
• Verify proper coding and report misuse to QA.
• Support quality assurance with the Bill Review team.
• Communicate with providers, clients and adjusters with professional service.
• Participate in ongoing training and other duties as assigned.

Connaissances

Customer service

Medical terminology

CPT codes

DRG knowledge

Communication skills

Interpersonal skills

Formation

High School Diploma

CPC coursework or certification

Outils

MS Word

MS Excel

Email

Description du poste

Description

Please note: At this time, we are not accepting or considering applicants residing in California (CA), New York (NY), or

Hawaii (HI).

Under the direction of the Bill Review Team Lead, the Provider Relations Specialist is responsible for assisting in a full range of provider relations and service interactions with the provider community, EK Health clients and partners. This position establishes and fosters relationships and works directly with the Bill Review team to resolve all requests related to bill processing.

Position Specifics:

Full-time, Non-Exempt position; working Monday through Friday 8-hour work day - 8am-4:30pm PST (Remote)

The job responsibilities will include, but are not limited to:

• Accurately and appropriately analyze all types of medical bills based on claim jurisdiction, medical notes, usual and customary rates (UCR), statutory regulations including state laws and fee schedules, available MPN/PPO contracts, coding guidelines, client instructions, and company policies and procedures
• Must be able to understand how a bill was processed and communicate to providers the methodology for processing and re-pricing the bill
• Receive all provider calls, emails and voicemails and respond within 48 hours
• Monitor the bill review process from initial receipt of bills through final payment
• Reviews and verifies the correct use of medical billing codes and reports the detection of improper use of billing codes to Client Inquiries, Enforcer or QA team
• Work with the Bill Review team on all quality assurance issues identified for review and handling
• Communicate with medical providers to obtain needed information to resolve bill-specific issues
• Communicate directly with clients, adjusters and providers offering excellent customer service by responding to and answering their questions quickly and professionally
• Participate in ongoing training to enhance job skills and knowledge
• Other duties as assigned

Pay & Perks

• Pay $19-21/hr based on experience, education and location
• Medical, Dental and Vision Insurance
• 401K
• Paid Time Off
• Paid Holidays
• Monthly internet stipend
• Equipment provided

Requirements

• High School Diploma required
• 2+ years of experience in complex Workers' Compensation Bill Review with customer service exposure.
• Knowledge of medical terminology, CPT codes, and DRG.
• High comfort level with computers and computer programs (MS Word, MS Excel, Email)
• Ability to read, analyze, and interpret technical procedures, medical reports, state laws and fee schedules.
• Hospital Bill Review experience a plus.
• CPC (Certified Professional Coding) coursework or certification a big plus.
• Strong Written and Oral Communication & Interpersonal Skills

Physical Requirements:

Candidate must be able to sit the majority of an 8-hour day except for lunch and break times. Candidate must be able to keyboard the majority of an 8-hour day except for lunch and break times. Candidate must have manual dexterity. Candidate must be able to speak on the telephone intermittently throughout the day. Candidate must be able to read and write English fluently. Candidate must be able to provide and confirm safe home office environment. Home office must be HIPAA compliant.

*Requires DSL, fiber, or cable internet connection from home 100 Mbps preferred or better.*