Provider Relations Specialist - Workers Comp - REMOTE!

About the position The Provider Relations Specialist assists with provider relations and service interactions involving the provider community, EK Health clients, and partners. Under the direction of the Bill Review Team Lead, this role establishes and fosters relationships and works with the Bill Review team to resolve requests related to bill processing. The position is full-time, non-exempt, and remote, with an 8-hour workday Monday through Friday from 8:00 a.m. to 4:30 p.m. PST. Applicants residing in California, New York, or Hawaii are not being considered.

Responsibilities

• Analyze medical bills based on claim jurisdiction, medical notes, usual and customary rates, statutory regulations, state laws and fee schedules, available MPN/PPO contracts, coding guidelines, client instructions, and company policies and procedures.
• Understand how bills were processed and explain the processing and repricing methodology to providers.
• Receive provider calls, emails, and voicemails and respond within 48 hours.
• Monitor bills through the bill review process, from initial receipt through final payment.
• Review and verify correct use of medical billing codes and report detected improper coding to the Client Inquiries, Enforcer, or QA team.
• Work with the Bill Review team on quality assurance issues identified for review and handling.
• Communicate with medical providers to obtain information needed to resolve bill-specific issues.
• Communicate with clients, adjusters, and providers, answering questions promptly and professionally.
• Participate in ongoing training to enhance job skills and knowledge.
• Perform other duties as assigned.

Requirements

• High school diploma.
• At least 2 years of experience in complex Workers' Compensation Bill Review with customer service exposure.
• Knowledge of medical terminology, CPT codes, and DRG.
• Comfort using computers and programs including MS Word, MS Excel, and email.
• Ability to read, analyze, and interpret technical procedures, medical reports, state laws, and fee schedules.
• Strong written and oral communication and interpersonal skills.
• Ability to sit and keyboard for most of an 8-hour day, except during lunch and breaks.
• Manual dexterity.
• Ability to speak on the telephone intermittently throughout the day.
• Ability to read and write English fluently.
• Ability to provide and confirm a safe home office environment that is HIPAA compliant.
• DSL, fiber, or cable home internet connection; 100 Mbps or better is preferred.

Nice-to-haves

• Hospital Bill Review experience.
• CPC (Certified Professional Coding) coursework or certification.

Benefits

• Medical, dental, and vision insurance
• 401K
• Paid time off
• Paid holidays
• Monthly internet stipend
• Equipment provided

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