Senior Workers' Compensation Compliance Analyst
$55,000–$65,000 year
Remote · United States
Job Summary
Senior Workers' Compensation Compliance Analyst responsible for reviewing state fee schedule rules, guidelines, regulations, and/or statutes for changes or compliance risks; drafting second level reconsideration letters; assisting with state disputes; determining if a medical coder or clinician is needed for audits; collaborating with the Director of Policy and Strategy Operations to implement system changes for risk mitigation in Workers’ Compensation fee schedules; providing internal consultations and training; developing compliance processes and procedures; partnering with other business units to ensure adherence to policies, procedures, and contracts; handling high-level appeals based on client or dollar threshold; negotiating with attorneys for state disputes; establishing special reimbursement policies; and contributing to overall risk mitigation and regulatory compliance initiatives. Qualifications include 5+ years in healthcare fraud/compliance/legal, 3+ years with medical reimbursement methodologies, 3+ years understanding medical coding/billing, knowledge of liability in property & casualty insurance, coding parameter understanding, strong research, communication, analytical, and software skills, and readiness to work independently and in a team. Benefits noted include comprehensive medical/dental/vision and life insurance, 401(k) with match, HSA/FSAs, PTO, EAP, and EOE statement.
Required 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
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