Senior Appeals Specialist - Workers' Compensation

5 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 bill 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.

Manage a caseload of post-payment Workers’ Compensation bills, including those related to state disputes and usual and customary rate (UCR) disputes.

Assigned high priority clients in managing all items related to the service with Reliant

Conduct proactive outreach 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.

Educate providers on Workers’ Compensation billing and reimbursement policies and regulatory requirements.

Document all provider communications thoroughly, including contact information, bill details, proposed and counter-offered payment rates, and final resolution in claim platform.