Medical Claims Appeal Specialist

1 week ago

Remote, Oregon, United States Reliant Health Partners Full time

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 Medical Claims Appeal Specialist, you are responsible for contacting providers to educate on NSA process/payments, respond to appeals for various products, and negotiate these post pay appealed claims to resolve payment disputes.  

Primary Responsibilities

  • Monitor and manage your post payment queues.
  • Conduct outreach, education, and negotiation calls to providers for post payment claims.
  • Effectively communicate with providers to verify/confirm understanding of NSA claims payments and regulations.
  • Effectively communicate with providers to explain claim payments for various pricing products.
  • Maintain compliance, including but not limited to Confidentiality and HIPAA requirements.
  • Maintain acceptable levels of production including but limited to turn around time standards as mandated by the regulation(s).
  • Document all conversations and record name, phone number, and email of contact person if available, payment rates offered on behalf of clients, and any counter offers by the provider.
  • Adhere to client specific and Reliant protocols, scripts, and other requirements.
  • Develop a comprehensive understanding of the state and federal regulations that will impact payments to providers.
  • Develop a comprehensive understanding of our various products.
  • Perform other job-related duties and special projects as required.

Qualifications

  • 2-3 years of related job experience – appeals, negotiations, medical billing.
  • Experience conducting outreach to providers via phone calls or other communication means.
  • Experience understanding Reliant critical behaviors and compliance requirements.
  • Broad healthcare policy and payment understanding.
  • Experience with claims workflow tools or systems.

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.

Pay Transparency

$50,000 - $60,000 USD

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)

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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