As our Complex Denials Consultant, you will represent and counsel healthcare providers in their disputes with medical insurance carriers and managed care organizations at all stages of the administrative appeals process. Every day, you will handle contract review and appeal template development based on contractual provisions and applicable state and federal laws, writing appeals and letters to insurance companies to resolve denials, and reviewing high-balance or complex accounts. To thrive in this role, you must maintain a foundational understanding of Commercial, Governmental, Managed Care, and ERISA regulations regarding payment, coverage, conditions of participation, and other relevant topics.
Here's what you will experience working as a Complex Denials Consultant:- Assist recovery staff in pursuing appeals, including the development of new and innovative legal and procedural arguments and tools.
- Draft complex and contractual appeals and letters to insurance companies.
- Review and apply client contract language and rates to resolve denied claims.
- Utilize payer-provider and administrative manuals to dispute denied claims.
- Contact provider representatives or higher-level resolution units to resolve complex claim and appeal issues.
- Represent clients during Administrative Law Judge hearings as needed.
- Assist with the training of recovery staff team members and provide necessary feedback as requested by management.
- Apply provider-specific reimbursement methodologies, payment policies, and provider contracts to fully confirm payment.
Required Qualifications- Law degree from an accredited college or university.
- Barred in one state or must be bar-eligible within 6 months of graduation.
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%
