Bill Review Specialist

Posted 6 months ago

Under moderate supervision, this position is responsible for processing and auditing complex and/or high level medical bills in accordance with state Workers’ Compensation fee schedules rules and regulations, UCR, correct coding rules and PPO application/interface through the use of the Medata software. Bills will be processed in accordance with state mandated timeframes, client contractual requirements and established department production standards.

Duties / Responsibilities

  • Enter and review workers compensation or no fault medical bills into the Medata system
  • Analysis and review of 1 or more assigned states
  • Perform technical or specialty review in one or more of the following areas:
    • Complex Hospital, Surgery, Levels of Service, IME’s, etc
    • Reconsideration Requests
    • Quality Assurance Reviews
  • 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
  • Perform quality assurance audits to ensure reviews are accurate
  • Proactively identify system and/or bill review issues and provide feedback to supervisors or manager
  • Other duties as determined by the Management

Requirements

  • High School diploma or equivalent – Associates Degree preferred.
  • Ability to review higher complexity bills for facility and/or professional services.
  • Knowledge for Worker’s Comp rules, regulations, and UCR and fee schedule rates.
  • Ability to properly address provider requests to reconsider allowances
  • Quality Review and  PPO Network experience a plus
  • Extensive knowledge of Workers’ Compensation medical fee schedules ( multi-state preferred ), state specific regulations, Medicare guidelines, ICD-9, CPT and HCPCs codes
  • 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 coding
  • Effective written and verbal communication skills

Job Application

  • Accepted file types: pdf, doc, docx, jpg, png.