Provider Relations Specialist

About Carisk Partners, Inc.Carisk Partners, a Best Places to Work award winning organization, is a specialty risk transfer, care-coordination company servicing insurers, government entities, self-insured plan sponsors and other managed care organizations. Through its Pathways 2 Recovery care model, Carisk Partners aims to improve outcomes and reduce overall cost of quality care by applying best practices in a patient – centered approach to manage complex challenges for the group health, casualty and auto markets.Role OverviewThe Provider Relations Specialist serves as a key liaison between healthcare providers and the Workers' Compensation Payment Integrity Department. This position is responsible for supporting provider engagement, resolving reimbursement inquiries, facilitating provider education, and assisting with dispute resolution activities. The Specialist works collaboratively with internal teams to ensure accurate reimbursement outcomes while maintaining positive provider relationships and supporting organizational payment integrity objectives. The role requires strong knowledge of workers' compensation reimbursement methodologies, provider billing practices, and payment integrity processes, as well as exceptional communication and problem-solving skills.Role ResponsibilitiesProvider Support and Relationship ManagementServe as a primary point of contact for healthcare providers regarding reimbursement inquiries, billing questions, and payment-related concernsDevelop and maintain productive working relationships with hospitals, physician offices, ambulatory surgery centers, and ancillary providersRespond to provider inquiries in a timely, professional, and customer-focused mannerReimbursement and Dispute ResolutionResearch and resolve provider questions related to bill review determinations, payment calculations, reductions, and reimbursement methodologiesAssist in the resolution of provider disputes, appeals, reconsideration requests, and escalated reimbursement issuesCommunicate payment determination rationale to providers in a clear and professional mannerCoordinate with bill review, coding, clinical, legal, and operations teams to facilitate issue resolutionRegulatory ComplianceMaintain knowledge of applicable workers' compensation regulations, fee schedules, and reimbursement requirementsEnsure provider communications are consistent with regulatory requirements and organizational policiesSupport internal compliance initiatives and audit activities as requestedOperational SupportDocument provider interactions, inquiries, and resolutions within designated systemsMaintain accurate records of provider disputes, escalations, and communication activitiesParticipate in process improvement initiatives designed to enhance provider experience and operational efficiencyRole QualificationsAssociate's or Bachelor's degree in Healthcare Administration, Business Administration, Finance, Nursing, or a related field preferredEquivalent work experience may be substituted for formal education2 to 5 years of experience in workers' compensation, healthcare reimbursement, provider relations, medical billing, claim operations, payment integrity, or bill reviewExperience interacting with healthcare providers and resolving reimbursement-related issues preferredStrong customer service and relationship management skillsExcellent verbal and written communication abilitiesEffective conflict resolution and problem-solving skillsStrong attention to detail and analytical capabilitiesAbility to manage multiple priorities and meet deadlinesAbility to communicate complex reimbursement concepts clearly and professionallyMicrosoft Office Suite, including Excel, Word, Outlook, and TeamsClaims management, bill review, or reimbursement platformsExperience with provider databases and reporting systems preferredRelationship BuildingCustomer Service ExcellenceConflict ResolutionCommunication SkillsAccountabilityRegulatory ComplianceTeam CollaborationAttention to DetailCulture and Benefits at Carisk:10 Paid Company HolidaysPaid Time OffCompetitive Medical, Dental, and Vision InsuranceCompany Sponsored Life InsuranceSupplemental Life Insurance, Short/Long Term Disability, Employee Assistance Program, Flexible Spending Account, and many other Ancillary Benefits401(k) Retirement Plan with Company MatchClassPass Wellness ProgramEmployee Discount Program Flexible and Hybrid Schedule Options*Internal Education Programs and Tuition Reimbursement OptionsInternal Advancement OpportunitiesCompany-Wide Diversity and Holiday CelebrationsBest Places to Work Award Recipient 5 years in a row! *Schedule options and work location vary between departments and management approvalCarisk Partners provides equal employment opportunities to all employees and applicants for employment, and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.