Appeals Intake Specialist Full-time Job

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 an Appeals Intake Specialist, you will play a critical role in resolving post-payment disputes related to Workers’ Compensation bills. This includes conducting provider outreach, negotiating disputed charges, and ensuring compliance with state-specific regulations.

Your work will directly support our cost containment efforts and ensure appropriate bill reimbursement for our clients.Primary ResponsibilitiesResponsible for screening/returning all voicemails and answering questionsOffer guidance to providers including sharing details on documents needed to process their appeal/reconsideration requestIf the situation appears to have issues escalating to the senior appeal specialist for directionResponsible for monitoring/managing the shared appeals inboxLocating the bill in question and assigning to the appropriate team member for handlingCreation of appeal case in Salesforce or ClaimsaveUpdate the attorney referred cases spreadsheet based on received emailsBimonthly report updates shared with clients on cases referred to attorneysResponsible for updating claim platform with new status received from attorneysWork with senior appeal specialist on updates needed to the process SOP’sInsures accurate and thorough documentation in claims platform for every email and voicemail.Demonstrates knowledge about workers’ comp and Reliant processesAdheres to our department TAT, either individual claim based or organization wideUnderstands the support function of the job and assumes responsibility for assignments.Establishes and prioritizes job tasks, desired solutions to problems and develops a realistic plan for their accomplishment.Qualifications1 -2 years of relevant experience in Workers’ Compensation bills or appeals.Strong understanding of Workers’ Compensation reimbursement methodologies, state regulations, and provider billing practices.Experienced communicator with providers and clientsAbility to collaborate with a variety of individuals both internally and externally.Familiarity with claims processing systems and provider communications.Excellent communication and organizational skills.Requires organizational skills, communication proficiency, discretion, ethical conduct, decision making, technical skillsIndividual 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$50,000—$55,000 USDBenefitsComprehensive medical, dental, vision, and life insurance coverage401(k) retirement plan with employer matchHealth 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.