Reliant

Compensation

Full Description

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 IDR dispute specialist, you are responsible for all IDR disputes, documenting the dispute in the queue, managing the queue, responding to the initial dispute, requesting IDRe/admin fees payment from the finance team, research disputes and submit to the compliance team for offer and supporting documents, compiling folders for individual disputes & cataloging documents, responding to initiating providers/IP, CMS and IDRe inquires. Primary Responsibilities Monitor, manage and add appeals to the queue. Monitor and manage all IDR emails from CMS, initiating provider, finance, compliance team and client. Research and communicate via CMS portal for the initial dispute within 3 business days from the received date. Research and communicate with the finance team for IDRe/admin payment within 3-5 business from the received date. Research and communicate with the compliance team to request an offer & supporting documents for the IDRe within 3-5 days business days from the received date. Document & upload IDR documents in queue. Compile folders for individual disputes to catalog documents and prep for offer & supporting documents from our compliance team. Communicate IDR rulings with NSA Manager & compliance team. Process IDR rulings and if needed, send adjustment to the client. Document all IDR processes in manual. Highlight special scenarios and maintain examples for complex disputes and or rulings. Maintain acceptable levels of production including but limited to turn around time standards as mandated by the regulation(s). Adhere to client specific and Reliant protocols, scripts, and other requirements. Perform other job-related duties and special projects as required. Other duties as assigned Qualifications 2-3 years of relevant job experience – No Surprises Act, negotiations and or medical claim processing. Experience conducting outreach to clients & providers via email or other means of communication. Experience understanding company critical behaviors and compliance requirements. Broad healthcare policy and payment understanding. Experience with claims workflow tools or systems. Individual 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—$60,000 USD Benefits: Comprehensive medical, dental, vision, and life insurance coverage 401(k) retirement plan with employer match Health 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.