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.
Responsibilities:
- Enter and review workers compensation or no fault medical bills into the Medata system
- Analysis and review of 1 or more assigned states having fee schedules
- Select proper PPO network based on client instructions
- Add or update Provider and Claim information as appropriate
- 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
- Other duties as assigned
Requirements/Skills/Qualifications:
- High School diploma or equivalent
- Proficiency as a Bill Review Analyst with two or more years previous experience in medical bill review (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
Preferred Qualifications:
- Experienced Medical Bill Reviewer Designation
- Strong written and verbal communication skills
- Certification in Coding
