Technology-driven revenue cycle management services for healthcare providers.
Complex Denials Consultant
Location
Worldwide
Posted
48 days ago
Salary
$90K - $112.8K / year
Seniority
Senior
Job Description
Complex Denials Consultant
R1 RCM
Complex Denials Consultant Locations: Remote, USA Remote, TX Full time Job Description R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Complex Denials Consultant, you will represent and counsel healthcare providers in their disputes with medical insurance carriers and managed care organizations at all stages of the administrative appeals process. Every day, you will handle contract review and appeal template development based on contractual provisions and applicable state and federal laws, writing appeals and letters to insurance companies to resolve denials, and reviewing high-balance or complex accounts. To thrive in this role, you must maintain a foundational understanding of Commercial, Governmental, Managed Care, and ERISA regulations regarding payment, coverage, conditions of participation, and other relevant topics. Here’s what you will experience working as a Complex Denials Consultant: - Assist recovery staff in pursuing appeals, including the development of new and innovative legal and procedural arguments and tools. - Draft complex and contractual appeals and letters to insurance companies. - Review and apply client contract language and rates to resolve denied claims. - Utilize payer-provider and administrative manuals to dispute denied claims. - Contact provider representatives or higher-level resolution units to resolve complex claim and appeal issues. - Represent clients during Administrative Law Judge hearings as needed. - Assist with the training of recovery staff team members and provide necessary feedback as requested by management. - Apply provider-specific reimbursement methodologies, payment policies, and provider contracts to fully confirm payment. Required Qualifications - Law degree from an accredited college or university. - Barred in one state or must be bar-eligible within 6 months of graduation. For this US-based position, the base pay range is $90,000.00 - $112,762.49 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training. This job is eligible to participate in our annual bonus plan at a target of 10.00% The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package. R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories. If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.
Related Guides
Related Categories
Related Job Pages
More Consultant Jobs
DOE Professional Development & Mentorship Consultant (CONTRACT ROLE) Location: United States, Remote Contracted Experienced Job Description Background The U.S. Department of Energy Alumni Network seeks to foster a collaborative community that champions a transformational science and technology agenda for the United States by facilitating non-partisan policy engagement, preserving and sharing institutional knowledge, and supporting career development and networking opportunities for its members. The Network, which is housed within the Environmental Protection Network, seeks to: - Foster an Alumni Community: Grow a strong and connected alumni community, foster career growth and professional development, and maximize the impact of the community. - Support DOE’s Mission Space: Support priorities, programs, and people within the DOE mission space and provide guidance on DOE capabilities, rules, and processes to affiliated stakeholders. - Envision the Future of DOE: Play a central role in the ideation and actualization of the modernization of the Department. About the Position The U.S. Department of Energy (DOE) Alumni Network is looking for a part-time consultant to facilitate professional development activities and the mentorship program for the Network. This work is undertaken in concert with the members and leadership of the Alumni Support Working Group. Reporting to the DOE Alumni Network Community Lead, AnneMarie Horowitz, the Alumni Support Consultant will support professional development resources, events, and programs that align with the needs and interest of the members of the Network. This position is remote and occasional travel to organizational meetings or in-person alumni events may be requested. Position Description Advise and Execute on the DOE Alumni Network’s Alumni Support efforts including: - Work to support the alumni community in professional development, with particular focus on career training and transition assistance for the large portion of members who more recently left the agency. - Work closely with the Community Lead, Executive Director, other senior staff, working group leads, and others to support the DOE Alumni Network’s community support. - Engage with the Alumni Support working group and help coordinate alumni efforts to support one-another in professional development and career transition. - Oversee the Network’s mentorship program. - Other duties as assigned. Areas of focus include but are not limited to: - Execution of mentorship program, including overseeing volunteer recruitment and engagement to complete one-month and six-month (program completion) check-ins with mentees and mentors and any interim program activities and close out celebration. - Plan and execute the second round of the mentorship program incorporating lessons learned and feedback received from participants and volunteers. - Coordinating online (and/or in-person) career support events to serve the needs of job-seeking and career transitioning alumni, at least one per month. This includes: 1) developing event ideas that best serve the community’s needs in conjunction with members; 2) coordinating with event volunteers the event agenda, logistics and details, developing content, and recruiting and prepping the highest quality speakers to ensure maximum excellent discussion and effective participant interaction; 3) marketing the events to the Network members to ensure maximum attendance; and 4) following up including metric tracking, SOP refinement, and collecting pictures, screenshots, recordings, and/or attendee testimonials for inclusion in future materials. - Maintaining and adding to a suite of resources for job seekers, with support from the Community Lead. - Contribution of content to the weekly newsletter that offers career support resources and updates on career development events. Who We are Looking For: - Must have worked at the U.S. Department of Energy (either fellow, contractor, or federal employee) for at least two years with additional experience preferred. - Five or more years of combined experience with professional development content, and building and managing communities and volunteers. - Enjoys working on teams and collaborating on the development of events and content to meet organizational and individual needs. - Innovative thinker, able to develop solutions to the evolving needs of a growing organization. - Flexible and willing to address new requests and tasks as they arise. - Strong preference for someone who is already engaged with the DOE Alumni Network, demonstrating commitment to its efforts and familiarity with its work. Compensation: We are aiming to secure a contractor for a $7,000 monthly scope of work. Travel and associated costs incurred, if requested, will be compensated.
• Lead Technical Implementations Own post-sale onboarding with a focus on LMS, HRIS, CRM, Convo Intelligence, SSO, and web embed integrations • Configure complex workflows and reporting solutions • Serve as the technical lead in customer rollout projects • Customize and Build Content Create tailored roleplays, personas, and scorecards aligned with customer workflows • Ensure training and content are embedded and role-relevant for end users • Collaborate Across Teams Work with CSMs (adoption and training), Support (technical troubleshooting), and Sales Engineers (pre-sales and scoping) to create a seamless customer experience • Clearly delineate responsibilities with other teams to reduce overlap and ensure efficiency • Define standard operating procedures • Collaborate on better professional services pricing and packages
Role Description We are looking to add a Sr. Workday Consultant (HCM) to join our growing organization. Services Delivery - Project / Functional Lead for consulting delivery for Workday HCM. - Conducts business process analysis, documents decisions and configures requirements. - Creates recommendations and solutions for configuration and design and shares Workday HCM best practices. - Delivers project management, manages project scope, timeline and budgets and works thru issue resolutions. - Leads testing, writes test scripts, stages testing data and testing issue solutions. - Manages multiple projects. Services Sales - Provide support for sales opportunities with focus on Workday HCM. - Provide support for Workday HCM product demo for services sales team. - Provide support with Workday HCM on sales calls and meetings. - Provide support with development of sales services package offerings. Qualifications - Bachelor’s Degree or equivalent required. - 5+ years of experience with Workday HCM implementation required with proven project delivery through full project lifecycle for Core HR, Compensation, Absence, Benefits, Recruiting, Onboarding, Talent Management or Payroll. - 5+ years of cloud technology implementation and project management and/or Functional Lead experience required. - 2+ years of Workday HCM product demo support a plus. - 2+ years of Workday HCM sales scoping support a plus. - Strong understanding of business processes within HR at all levels (Employee, Managers and HR Business Partners). - Consistently demonstrates a customer-first philosophy and the organization's core values of innovation, excellence, and integrity. - Problem analysis, use of judgment and ability to solve problems efficiently. - Effective communication skills. - Decision making, critical thinking. - Superior customer service skills. - Operation and system analysis. - Background in project management. - Ability to present to companies virtually and onsite. - Ability to multi-task in a fast paced environment. - Must be a self-starter. Requirements - Location: This is a home based position. Candidates must have a home office with a way to connect to the internet. - Job Type: On Demand, As Needed for Projects. - Employment Status: Contractor. - Work Status: Must be eligible to work in the US / No sponsorship available. - Travel: This position will require travel to US client locations (25%) / No sponsorship available. Equal Opportunity Employer Acuity HCM is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, national origin, age, marital status, genetic information, disability or protected veteran status. Employees will be treated on the basis of their job-related qualifications, ability and performance. It is also our policy that sexual harassment or any other kind of harassment including harassment based on sexual orientation will not be tolerated. The foundation of these policies is our commitment to treat everyone fairly and equally and to have a bias-free work environment.
Role Description The Franchise Business Consultant is responsible for advising and assisting franchisees in all appropriate areas of their business. The Business Consultant will be assigned a territory consisting of approximately 50 restaurants. This position will work from home and travel extensively within the assigned territory. What You'll Own (Core Responsibilities) - Financial and Operational Oversight - Achieves financial and operational results through effective oversight of operations programs and initiatives. - Reviews P&L reports for each location in territory on a regular basis, leads analysis discussions with FO's and supports the development of action plans for improvement. - Formulates action plans and sets deadlines for completion/compliance where needed. - Franchise Consultation & Support - Completes targeted number of restaurant/Franchise Owner's (FO's) visits and provides exemplary business consulting services to Franchisees to drive their success. - Plans field time appropriately to gain efficiencies and utilizes all systems and tools needed to execute highly effective visits. - Works through FO's to resolve critical issues immediately. - Maintain customer complaint resolution procedures and addresses issues at the restaurant level with the FO. - Cross-Functional Collaboration & Program Management - Works as needed with cross-functional teams such as R&D, marketing, purchasing, training and others to launch and achieve targeted results for operations programs and initiatives. Ensures all FO's participate in all initiatives. - Launches new operational programs, food products/other promotional items associated with the annual marketing calendar. - Executes brand marketing plan. - Leadership Development & Standards Compliance - Builds leaders; provides continuous leadership to his/her FO's related to leadership and successful operations management. - Ensures specifications/Standard Operating Procedures and Food Safety procedures are followed (proper Brand representation). - Focuses on Operation evaluations and follow-up procedures. - Customer Experience - Ensures franchise participation in the Customer Experience program and uses data to coach, counsel and recognize operators. Qualifications - Undergraduate and/or graduate degree or equivalent experience and 5 - 7 years of restaurant/franchise operations experience. - Quick service, multi-unit franchise operations, and/or hospitality industry experience. - Ability to travel 80% of time. - Ability to work weekends and evenings if needed. - Ability to lift 40 lbs. - Strong financial acumen, analysis/problem solving, negotiating and influencing skills. - Proficiency in Microsoft computer skills, i.e. Word, PowerPoint, Excel, Outlook, Teams. Benefits - Paid time off. - Health insurance. - Dental insurance. - Healthcare spending or reimbursement accounts such as HSAs or FSAs. - Retirement benefits or accounts. - Gym memberships or discounts. - Commuting/travel assistance. - Flexible schedules. - Employee discounts.
