Bill Reviewer III

About the role

Under limited supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers’ compensation fee schedule by performing the following duties.

Responsibilities

• Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output.
• Performs preliminary screening for appropriateness and medical necessity of services rendered.
• Uses CPT and ICD9/ICD10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational.
• Flags any problem bills to the BR supervisor.
• Communicates with clients and/or providers to clarify information.
• Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers.
• Able to price hospital and surgery bills to applicable fee schedules.
• Able to process reconsideration requests as assigned.
• May specialize in state specific or client specific areas of responsibility.
• May assist in answering provider calls.

Requirements

• High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers’ comp environment.
• Strong knowledge of CPT and ICD9/ICD10 coding and workers compensation fee schedules. Must be familiar with workers’ compensation regulations and have good comprehension of company software system process.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
• Knowledge of Word Processing software; Spreadsheet software and Database software.
• Medical Bill Reviewer Designation – 40 hour initial certification plus continuing education hours of 16 hours every 2 years.

Qualifications

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Excellent oral and written communication skills.
• Comprehensive medical, dental, and vision benefits.
• Company contributions to HSA and FSA plans.
• Employer paid life and disability insurance.
• 401(k) with company match.
• Paid time off (PTO) and company paid holidays.
• Learning and development opportunities that support real career advancement.
• Employee assistance resources and a supportive culture that values balance and wellbeing.

Benefits

• We take care of our people so they can take care of their work and their teams!
• Comprehensive medical, dental, and vision benefits.
• Company contributions to HSA and FSA plans.
• Employer paid life and disability insurance.
• 401(k) with company match.
• Paid time off (PTO) and company paid holidays.
• Learning and development opportunities that support real career advancement.
• Employee assistance resources and a supportive culture that values balance and wellbeing.

Pay

$26-$28/hr

Schedule

Eight-hour shift