Provider Relations Specialist

The Provider Relations Specialist is responsible for assisting in a full range of provider relations and service interactions with the provider community, clients and partners. This position establishes and fosters relationships and works directly with the Bill Review team to resolve all requests related to bill processing.

Job Responsibility

• Accurately and appropriately analyze all types of medical bills based on claim jurisdiction, medical notes, usual and customary rates (UCR), statutory regulations including state laws and fee schedules, available MPN/PPO contracts, coding guidelines, client instructions, and company policies and procedures.
• Must be able to understand how a bill was processed and communicate to providers the methodology for processing and re-pricing the bill.
• Receive all provider calls, emails and voicemails and respond within 48 hours.
• Monitor the bill review process from initial receipt of bills through final payment.
• Reviews and verifies the correct use of medical billing codes and reports the detection of improper use of billing codes to Client Inquiries, Enforcer or QA team.
• Work with the Bill Review team on all quality assurance issues identified for review and handling.
• Communicate with medical providers to obtain needed information to resolve bill-specific issues.
• Communicate directly with clients, adjusters and providers offering excellent customer service by responding to and answering their questions quickly and professionally.
• Participate in ongoing training to enhance job skills and knowledge.

Skills Required

• High School Diploma required.
• Excellent Communication Skills – Verbal & Written.
• 2+ years of experience in complex Workers' Compensation Bill Review with customer service exposure.
• Knowledge of medical terminology, CPT codes, and DRG.
• High comfort level with computers and computer programs (MS Word, MS Excel, Email).
• Ability to read, analyze, and interpret technical procedures, medical reports, state laws and fee schedules.
• Hospital Bill Review experience a plus.
• CPC (Certified Professional Coding) coursework or certification a big plus.
• Strong Written and Oral Communication & Interpersonal Skills.

What We Offer

• Competitive salary pay
• Flexible work-from-home opportunity
• Health insurance
• Sick and vacation time off
• Paid training
• Supportive team environment
• Opportunities for growth and advancement