复杂拒赔顾问（复杂索赔）
Complex Denials Consultant (Complex Claims)
R1 是领先的科技驱动解决方案提供商，致力于改善医院、医疗系统和医疗集团的患者体验和财务表现。我们是唯一一家将全球收入周期专业人员的深厚专业知识与行业最先进的技术平台相结合的公司，该平台涵盖复杂的分析、人工智能、智能自动化和流程编排。
作为与复杂索赔团队合作的复杂拒付顾问，您将代表医疗机构处理工伤（WC）、机动车事故（MVA）、第三方责任（TPL）和退伍军人事务（VA）索赔的争议。您将负责解读和应用特定州的法规，提供关于账单顺序的指导，并向内部利益相关方建议快速高效地追回被拒付索赔的战略方法。要在这个职位上取得成功，您必须保持对支付、保险覆盖、留置权提交实践和其他相关主题的适用法规的基础理解。
以下是您作为复杂拒付顾问将经历的工作内容：
- 监督并协助追回被拒付的 WC、MVA、其他 TPL 和 VA 索赔。
- 根据需要起草复杂的上诉、通信和其他文件。
- 理解并熟练应用与 WC 索赔相关的特定州法规。
- 监督留置权实践，确保其符合适用的州法律、患者保护法案和不断发展的判例法。
- 协助培训追偿团队成员，并根据管理层要求提供必要的反馈。
- 与外部律师协调策略、诉状、和解立场及成本效益分析。
- 为团队开发新的创新法律和程序性论点及工具。
- 培养专业、协作的关系，以促成有利的解决。
所需资格
- 来自认可学院或大学的法律学位。
- 在一个州已通过律师资格考试，或在毕业后的6个月内具备律师资格。
- 具有以下一个或多个领域的法律经验：
- 医疗法律
- 保险辩护或原告人身伤害
- 医院或医疗系统法律事务
- 复杂的报销或留置权诉讼
- 熟练掌握：
- MVA 法律和保险结构
- 医院留置权法规和执行
- 医疗报销中的监管合规
查看英文原文
R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.
As a Complex Denials Consultant working with the Complex Claims team, you will represent healthcare providers in their claim disputes for workers compensation (WC), motor vehicle accident (MVA), third party liability (TPL), and veterans’ affairs (VA) claims. You will be responsible for interpreting and applying state-specific statutes, providing guidance on billing sequencing, and advising internal stakeholders of strategic ways to quickly and efficiently recover on denied claims. To thrive in this role, you must maintain a foundational understanding of applicable regulations regarding payment, coverage, lien filing practices, and other relevant topics.
Here’s what you will experience working as a Complex Denials Consultant:
- Oversee and assist in the pursuit of reimbursement of denied WC, MVA, Other TPL, and VA claims.
- Draft complex appeals, correspondence, and other documents as appropriate.
- Understand and skillfully apply state-specific statutes related to WC claims.
- Oversee lien practices and ensure that they comply with applicable state laws, Patient Protection Acts, and evolving case law.
- Assist with the training of recovery staff team members and provide necessary feedback as requested by management.
- Coordinate with external counsel on strategy, pleadings, settlement posture, and cost-benefit analysis.
- Develop new and innovative legal and procedural arguments and tools for team usage.
- Foster professional, collaborative relationships to facilitate favorable resolutions.
Required Qualifications
- Law degree from an accredited college or university.
- Barred in one state or must be bar-eligible within 6 months of graduation.
- Legal experience with emphasis on one or more of the following:
- Healthcare law
- Insurance defense or plaintiff personal injury
- Hospital or health system legal affairs
- Complex reimbursement or lien litigation
- Strong working knowledge of:
- MVA laws and insurance structures
- Hospital lien statutes and enforcement
- Regulatory compliance in healthcare reimbursement
For this US-based position, the base pay range is $90,000.00 - $112,762.49 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.This job is eligible to participate in our annual bonus plan at a target of 10.00%The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.
Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.
R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.
If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.
CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent
To learn more, visit:
Visit us on Facebook
Originally posted on Himalayas