Bill Review Specialist

Bill Review Specialist

 

Rapidly expanding national workers' compensation medical bill review service and software provider is seeking top talent to contribute to our Company. We are currently seeking an exceptional individual to join our hardworking and fun team. SUMMARY

   

 Analyze billings for all State Workers’ Compensation medical claims by utilizing our proprietary software StrataWare to determine appropriateness of services billed.  Also, make bill review processing determinations according to rules and regulations for each state jurisdiction and/or third party partner, i.e. PPO. Responsibilities: Utilizes bill review skills and knowledge to evaluate medical bills and corresponding EORs for accuracy and compliance with state mandated fee schedule(s) and StrataCare business rules and practices. Reviews, analyzes, adjusts and releases queued eReview bills upon return from OCR - including successful, duplicated and/or simple PPO bills. Refers to reference library of fee schedules, CPT, ICD-9, HCPCS and other industry publications to support findings.Provides the highest level of customer service for current or prospective clients of the Company, vendors, staff, business partners or visitors. Assists and cooperates with co-workers, supervisor and management; collaborates with supervisor to develop skills and knowledge. Manages confidential client information with discretion and good judgment in accordance with department and company guidelines. Demonstrates a dependable work ethic. Performs all duties in accordance with established Company goals.

 

 

 

Qualifications:


These specifications are general guidelines based upon the minimum ordinarily considered essential to satisfactory performance in this position.   Individual skills and abilities may result in some deviation from these guidelines.  

 

To perform effectively in this position, the incumbent is required to have:

  Good working knowledge of Workers’ Compensation medical fee schedules, state compliance regulations, Medicare guidelines, ICD-9, CPT, RVS and other healthcare programs. Demonstrated attention to detail. Ability to meet productivity goals without compromising product quality and integrity. 10 key skills by touch and solid typing skills. Effective oral, written and communication skills. Good organizational skills. Competency to utilize Company software and proficiency in Microsoft software applications and a willingness to learn new systems as necessary. Ability to work overtime, as needed.

 

 

Typically these skills result from high school graduation and workers’ compensation/medical bill review experience.

The incumbent must be able to perform this job safely, without endangering the health or safety of him/herself or others.