Coder / Specialty Medical Bill Reviewer - Remote

Overview

The remote Coder/Specialty Medical Bill Reviewer is responsible for reviewing, auditing, and data entry of medical bills for multiple states and lines of business within both Worker’s Compensation and Commercial Health arenas. This would include analysis for the fee schedule or usual and customary application, as well as PPO interface, while meeting contractual client requirements.

In Short

• Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts
• Analysis and review of 1 or more assigned states having fee schedules
• Utilize Fee Schedules, Online Documents, Client instructions, and other training material to properly review medical bills
• Review medical bills for compensability and relatedness to injury
• Reprice medical bills to Workers’ Compensation Fee Schedule and PPO Network
• Research usual and customary/fee schedule applications and system interface as appropriate
• Communicates and defends to providers and clients the basis for the methodology used to accomplish the reduction of charges
• Responsible for producing a final review for the recommendation of payment to the client
• Maintain productivity, as well as speed and level of accuracy, as determined by company standards

Requirements

• Current knowledge of utilization review processes and managed care
• Knowledge of state-based fee schedules
• Strong knowledge of Medical Terminology and CPT/ICD-9/ICD-10 coding
• Ability to identify trends through analysis of practices to improve the overall utilization of resources and cost containment
• Ability to communicate those trends found through analytical study using a variety of reporting mediums
• Ability to work collaboratively and independently while meeting productivity standards
• Excellent relationship management skills
• Strong organizational and task prioritization skills
• Computer literacy on Microsoft Office products and database programs
• Must have a track record of producing highly accurate work, demonstrating attention to detail

Benefits

• Work remotely
• Inclusive work environment
• Equal Employment Opportunities