Total HealthCare Management
(a wholly owned subsidiary of SeaBright Insurance Holdings, Inc.)

Provider Relations Specialist
And
Sr. Bill Review Analyst

Total HealthCare Management is a rapidly growing provider of managed care services for workers compensation payers based in Irvine, CA. THM delivers best-in-class medical cost containment services for small, medium and large workers compensation customers. We currently have two openings, a Provider Relations Specialist and a Sr. Bill Review Analyst.

Responsibilities:
The responsibilities of these positions include, but are not limited to, the following:

" Responding to both written and verbal inquiries submitted by both our clients and/or providers.
" Answering incoming calls regarding the status of claims that come in to the Bill Review Department and returning calls with in 24 hours.
" Researching inquiries to ensure proper processing standards were adhered to.
" Reporting any system or user issues to management.
" Processing/auditing claims based on multiple jurisdictions.

Required Qualifications:
" High school diploma or GED required, some college preferred
" Previous experience in the Workers Compensation Bill Review Industry
" California MBR Certification
" Must have comprehensive knowledge of the California Official Medical Fee Schedule and other state fee schedules, rules, and regulations.
" Must have knowledge and understanding of UCR and PPO processing.
" Must have knowledge of CPT, ICD-9, HCPCS.
" Able to adhere to TAT requirements based on client and state specifics
" Ability to work independently and to research fee schedules and state websites to verify correct pricing
" Ability to read and understand the Workers Compensation rules and regulations
" Excellent verbal and written communication skills

We offer competitive salaries, health benefits, vacation time, paid holidays, and 401(k) with company match.

If this sounds like your career opportunity, please send your resume to resumes@thmnet.com. To increase your chances of getting noticed, please include a cover letter outlining your unique abilities and desire to grow with us. Its going to be a Bright future.
Please no agencies or recruiters.