Reviews, audits, and approves workers compensation and no-fault medical bills using fee schedules, PPO interfaces, client instructions, and the Medata system. Analyzes medical records, coding, terminology, billing history, and usual-and-customary applications to recommend payment. Maintains productivity, accuracy, and turnaround-time standards; performs quality reviews; researches billing issues; and escalates system or process concerns.
Job Purpose:
Under moderate supervision, this position is responsible for analyzing incoming medical bills for fee schedule or usual and customary application as well as PPO interface while meeting contractual client requirements. This position is also responsible for producing a final review for recommendation of payment to the client. Candidate will be required to maintain an acceptable productivity as well as speed and level of accuracy as determined by company standards and bill review manager. Pay rate is commensurate with experience.
Duties:
- Auditing and approving workers compensation and/or no fault medical bills in the Medata system
- Analysis and review of different fee schedule states and clients
- Utilize Fee Schedules, Online Documents, Client instructions and other training material to proper review medical bills
- Research usual and customary/fee schedule applications and system interface as appropriate
- Provide quality review on work as specified by Lead/Supervisor
- Proactively identify system and/or bill review issues and provide feedback to supervisors or manager
- Review of medical records and strong understanding of medical terminology.
- Review and understanding of prior billing history for each bill within our systems applications.
- All bills require review by a tenured and experienced reviewer with bill review knowledge and understanding of our systems applications.
- Adhering to the tight Turn Around Time on the review of bills, per the client’s request and needs.
- Other duties as assigned
Requirements/Skills/Qualifications:
- High School diploma or equivalent
- Proficiency as a Bill Review Analyst with three or more years previous experience in medical bill review or coding (workers’ compensation is a plus)
- Proficiency with 10-key pad at 9000+ kph or equivalent bill processing rate
- Ability to work in a high production environment while meeting productivity and quality standards
- Proficiency with Microsoft Word and Excel
- Strong knowledge of Medical Terminology and CPT / ICD-9 / ICD-10 coding – Knowledge of multi-state fee schedules preferred.
Preferences:
- Experienced Medical Bill Reviewer Designation
- Strong written and verbal communication skills
- Certification in Coding
- Certified Professional Coder (CPC) designation a plus
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