Ideal candidates will have worked in Self Insurance appeals or as a paralegal. Other commercial healthcare appeals or paralegal experience and those with a strong legal background will be heavily considered. Holding an RN or LPN is a plus. This position reports to the director of Executive VP of Claim Strategy and Specialty Networks.

Essential Functions:

• Initiate and coordinate responses with clients and providers.
• Capable of performing legal research to obtain accurate information and being able to communicate this information to legal, clinical and other staff.
• Must be proficient in communicating accurately, clearly and precisely with both clients and providers.
• Escalate issues when/if turnaround times may need to be reset
• Collaborate with ERISA attorneys as required.
• Coordinate with team members and senior management to clarify medical determination or clinical rationale.
• Perform legal research using primary legal sources including cases, constitutional and statues and administrative rules and regulations.
• Maintain files and logs for all appeals.

Must have good knowledge of insurance companies and both in and out of network appeals and billing. Knowledge and experience with insurance plans is a big plus. Looking for an individual to work on all aspects of appeal responses with a strong knowledge of medical terminology, billing requirements, and ability to interpret EOB's.

• Must be proficient in proofreading, spelling, grammar, punctuation, and math
• Must possess ability and willingness to plan, organize and accomplish tasks accurately, efficiently and in a timely manner for multiple team members.
• Ability to analyze, interpret, apply reason and logic, conduct research, structure a clear and thorough response
• Strong PC application and system skills
• Have high regard for the quality of work, accuracy, and confidentiality

EDUCATIONAL REQUIREMENTS

• Proficiency in medical billing/medical/legal terminology
• Healthcare payer experience highly preferred
• RN or LPN with paralegal experience is a plus.

About HPC

Health Payer Consortium (HPC) is a healthcare cost containment company headquartered in St. Louis, MO. We are particularly adept at identifying savings that other companies may have overlooked, or simply passed up. We work with TPAs, insurance companies, MGUs, Stop Loss Carriers, Taft-Hartley groups, and brokers. We believe that health plans should not pay for inflated bills and non-payable items, and we provide services to support them. We are problem-solvers who put the Client First, Always. Visit healthpayerconsortium.com or follow us on LinkedIn.

Job Type: Full-time

Pay: $50,000.00 - $75,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Ability to commute/relocate:

• St. Louis, MO 63146: Reliably commute or planning to relocate before starting work (Required)

Work Location: One location

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