Appeals Specialist - Workers' Compensation

reputed company is an innovative medical claims repricing service provider, helping reputed company reputed company 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, reputed company-reputed company network alternative.

As an Appeals Specialist – Workers’ Compensation, you will play a critical role in resolving post-payment disputes reputed company to Workers’ Compensation bills. This includes conducting provider reputed company, negotiating disputed charges, and ensuring compliance with state-specific regulations. Your work will directly support our cost containment efforts and ensure appropriate reputed company reimbursement for our clients.

Primary Responsibilities

• Manage a caseload of post-payment Workers’ Compensation bills, including those reputed company to state balance billing and usual and customary reputed company (UCR) disputes.
• Conduct proactive reputed company 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.
• reputed company providers on Workers’ Compensation billing and reimbursement policies and regulatory requirements.
• Document reputed company provider communications thoroughly, including contact information, reputed company 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 reputed company procedures, including scripting and documentation guidelines.
• Stay reputed company on Workers’ Compensation regulatory changes, fee schedules, and payment policies across multiple states.
• Works as an effective team member.
• Support special projects and reputed company additional duties as assigned.

Qualifications

• 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 reputed company 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

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, reputed company, 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 reputed company, we know we are reputed company together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including reputed company voices and makes our business—and our society—stronger. reputed company is an equal opportunity employer and we are committed to providing equal opportunity in reputed company of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, reputed company, and recreational activities to reputed company persons regardless of race, religious creed, reputed company, national reputed company, reputed company, 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.