Reliant Health Partners

Client Services Representative

• Research and resolve issues for negotiators, providers, and payors. Communicate via telephone and written correspondence. Utilize the Action Request Process to document and manage requests.
• Respond to client, negotiator or management requests in a timely manner. Follow department policies and procedures. Meet or exceed production, accuracy and turnaround time requirements.
• Review and update claim pends and exceptions, as assigned.
• Answer incoming calls, assist callers with questions and transfer calls to the proper individual when needed. Document calls as appropriate.
• Perform administrative duties
• Perform other job-related duties or special projects as required.
• Monitor inventory, queues and workload. Address concerns as appropriate, facilitate resolution of large dollar and high priority claims.
• Provide initial and on-going training to team members. Provide feedback to team members and/or management. Assist others in organizing, setting priorities, and monitoring workflow.
• Participate and support client implementations. Create and maintain reference materials and complete other assigned tasks. Handle special requests made by clients or account managers.
• Serve as backup support for the department leader, as needed.

Senior Client Services Representative

• Perform research internally and externally (via internet) to obtain supporting information within the Data Management department.
• Have the ability to identify information by categorizing and recognizing differences and similarities.
• Interact with providers to obtain and verify necessary information.
• Work assigned provider data queues.
• Develop a comprehensive understanding of our various products.
• 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

Compliance

• Assist with reviewing state fee schedule rules, guidelines, regulations, and/or statutes for changes or compliance risks with reimbursement
• Draft second level reconsideration letters
• Assist with drafting and responding to state disputes
• Determine if the second level reconsideration request requires a medical coder or clinician for audit
• Work with the Director of Policy and Strategy Operations or the equivalent role to assist in implementing system changes for risk mitigation in Workers’ Compensation fee schedules or gap logic
• Provide consultation internally or externally where appropriate
• Provide internal training where required for compliance
• Assist in the development of compliance processes and procedures
• Partner with other business units to ensure compliance with implementing, adopting, or expanding on the rules and/or regulations, including but not limited to policies, procedures, and contracts
• Responsible for handling high level appeals – either based on the client or dollar threshold
• Establish special reimbursement policies for identified TIN’s
• Other duties as assigned or requested
• Responsible for handling negotiation with attorneys for state disputes

Senior Client Services Representative

Client Services Representative

Senior Workers' Compensation Compliance Analyst