Senior Workers' Compensation Compliance Analyst

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.

Pay Transparency
$65,000—$70,000 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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