Medical Bill Coordinator - Remote

About the role

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Responsibilities

• Processes bills in accordance with multi-state schedules, rules, regulations, and guidelines.
• Applies PPO contract discounts to bills.
• Reviews operative reports to determine if surgery services were appropriately billed.
• Reviews complex medical, legal, and consult services.
• Contacts client or facility to obtain additional or missing information.
• Handles provider appeals where appropriate to fee schedule and contractual disputes.
• Communicates internal issues to management.
• Assists bill review team lead with workflow management, coaching, and mentoring of staff.
• Assists with process, procedure, and system training for new staff.
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travel as required.

Requirements

• High School diploma or GED required.
• Two (2) years workers' compensation and/or bill review experience or equivalent combination of education and experience required to include provider appeals experience.
• PPO re-pricing, surgery review, by report, and RNE review preferred.
• Two (2) years of experience with complex medical, legal, and consult review preferred.

Skills & Knowledge

• Knowledge of re-pricing rules and guidelines
• Knowledge of medical terminology, anatomy, and surgical terms
• Knowledge of multiple state jurisdictional regulations and rules
• Knowledge of Fee Schedules, Rules, and U&C Guidelines
• Knowledge of CPT/ICD9
• PC literate, including Microsoft Office products
• Leadership skills and ability to motivate others
• Strong verbal and written communication skills
• Strong interpersonal skills
• High level of accuracy and attention to detail
• Ability to multi-task and function in high volume area
• Ability to handle deadlines and proactively problem solve
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

Work Environment

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
• Physical: Computer keyboarding, travel as required
• Auditory/Visual: Hearing, vision, and talking

Pay

For the jurisdiction noted in this job posting only, the range of starting pay for this role is $18.00 - $23.00 per hour.

Benefits

• Medical, dental, and vision insurance
• 401k with matching
• Paid time off (PTO)
• Disability and life insurance
• Employee assistance program
• Flexible spending or health savings account
• Additional voluntary benefits