Medical Bill Auditor II
PURPOSE:
Quality control review and / or error correction and final adjudication of paper and electronic workers’ compensation medical bills. Determines whether to return, deny or pay bills following organizational policies and procedures. Provide customer service, including communicating information to hospitals, physicians and client representatives regarding reimbursement and claims status.
RESPONSIBILITIES AND DUTIES:
•Review complex workers’ compensation provider, pharmacy, DME, and hospital claims in accordance with jurisdictional and client specific guidelines.
•Resolve claim edits, verify client-specific rules, and review history records and determine eligibility for payment.
•Consistently meet established performance standards, including quantity and quality claims review standards.
•Provide customer service by responding to and documenting telephone and/or written inquiries.
•Maintain current knowledge of jurisdictional guidelines and effectively apply knowledge in the payment of claims,customer service, and all other job functions.
•Consistently demonstrate excellent attendance and punctuality.
•Meets all production and quality standards. Attends all required training classes.
•Elevate issues to next level of supervision, as appropriate.
QUALIFICATIONS:
•High school diploma or equivalent required, bachelor’s degree preferred.
•Minimum of 1 year experience processing medical, dental and/or hospital claims; basic knowledge of claimsadjudication principles and procedures, medical terminology and ICD-10 and CPT-4 codes.
•Solid organization skills with strong detail orientation and listening skills.
•Ability to read, analyze, and interpret general business materials, technical procedures, benefit plans andregulations.
•Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages.
•Highly developed sense of integrity and commitment to customer satisfaction.
•Ability to communicate clearly and professionally, both verbally and in writing.
•Proficient PC skills, including MS Outlook, Word and Excel.
•Able to maintain excellent attendance and punctuality.
•Excellent critical thinking and decision-making skills.
•Ability to work under pressure.
•High attention to detail.
*The Responsibilities and duties of this position may be modified from time to time at the discretion of the executive team.
To apply, send resume and cover letter to [email protected].
