Note: The job is a remote job and is open to candidates in USA. R1 RCM is the leading provider of technology-driven solutions that transform the patient experience and financial performance of healthcare organizations. As a Complex Denials Consultant, you will represent healthcare providers in claim disputes and be responsible for navigating complex reimbursement issues, ensuring compliance with state laws, and collaborating with various stakeholders to optimize claim recovery.
Responsibilities
- 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
Skills
- 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
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