Provider Reimbursement Strategist

Introduction

Zenith is a team of Workers' Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers' Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional.

Overview

Under general direction and within Zenith guidelines, in collaboration with team members, develops and and executes negotiation strategies to achieve the most reasonable and fair reimbursement.

Responsibilities

• Negotiate directly with providers for the most reasonable reimbursement of medical bills in accordance with the respective jurisdictional rules and regulations.
• Use critical-thinking to make decisions affecting the outcome of payments to direct-providers.
• Provides consultative recommendations to other departments on disputes, pre-servioce agreements, and settlements based upon negotiations experience and knowledge of successful strategies employed in those negotiations.
• Contract directly with providers and execute legible, effective and concise negotiation agreements.
• Ensure negotiations comply with regulatory and company timelines.
• Document all negotiation activities and savings that occur.
• Develop and preserve effective working relationships with the provider communities and billing entities that render health services to Zenith insureds.
• Seek, identify and implement process improvements.
• Periodically evaluate plan of action on projects and change approach when it appears that the desired outcome is not being reached.
• Understand Workers' Compensation regulations to determine negotiation strategies for fair and reasonable reimbursement.
• Coordinate and perform research as required (i.e. provider participation assisting in lien defense, special projects, assist in A/R research, etc.).
• Applies principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
• Provide problem solving regarding network information requests.
• Evaluate provider trends and collaborate with various business functions to arrive at the best negotiated outcomes with direct-providers.
• Review and discuss cost drivers and opportunities for further control.
• Manage the overall relationship of select trading partners.
• Develop direct in-person relationships with providers identified through trend analysis to impact overall medical cost.
• Identify and execute cost containment strategies for all states.
• Serve as a local resource of the Provider Relations department to impact provider relations for branch offices.
• Work productively and harmoniously with others on a consistent basis.
• Respond positively to direction and feedback on performance.
• Consistently maintain professional and appropriate demeanor.
• Perform other duties as assigned.

Education

• High School Diploma Or equivalent required
• Bachelor’s Degree or equivalent combination of training/experience preferred

Work Experience

• 2+ years progressively responsible Workers' Compensation bill review experience required
• 2+ years in position(s) where negotiation was an integral part of the job duties preferred

Knowledge, Skills, and Abilities

• • California Bill Review Designation preferred.
  • Expert negotiation/influencing skills with demonstrated ability to influence negotiated outcomes.
  • Excellent written and verbal skills.
  • Meets all state regulatory standards regarding licensing, continuing education, and other requirements.
  • Action-oriented; results-oriented; with demonstrated ability to work with sense of urgency and manage multiple projects simultaneously and expeditiously.
  • Strong customer-service skills
• Licenses and Certifications
  • Certified Coder-AHIMA or AAPC preferred.

Pay, Benefits, and Other Information

The expected salary range for this position is $59,765 - $74,707. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law. Qualifications may warrant placement in a different job level.Benefits

• Medical, Dental and Vision Insurance
• Flexible Spending Accounts
• Paid Parental Leave
• Life, AD&D and Disability Insurance
• 401(k), Employee Share Purchase Plan (ESPP)
• Education and Training Reimbursement
• Paid Leave: 3 weeks/year Vacation, 2 weeks/year Sick Leave
• 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays
• Employee Assistance Program (EAP)
• For more information, review details on the Benefits page of our Career Site: https://www.thezenith.com/careers/benefits/

Zenith typically posts jobs for a minimum of 8 to 14 calendar days. If you are interested in any of our open positions, we encourage you to submit your application promptly.Zenith Insurance Company is an equal opportunity employer and considers all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristic. In compliance with California law, we are committed to fair hiring practices. Pursuant to the California Fair Chance Act (AB 1008), we will consider qualified applicants with criminal histories in a manner consistent with the law. Additionally, in accordance with the Los Angeles Fair Chance Initiative for Hiring Ordinance, we will not inquire about an applicant’s criminal history until after a conditional offer of employment has been made.If you are a qualified individual with a disability or a disabled veteran and need assistance accessing our career center or applying for a position due to your disability, you are entitled to request an accommodation. To make a request, please contact a Human resources representative at Zenith Insurance Company.#LI-EF1#LI-HYBRID