Description

Summary:

Employee is a Lead Bill Reviewer who will assist the Bill Review Supervisor in a variety of functions related to the ultimate goals of the department.

This position may be considered to work from home under the following criteria:

• Candidate’s commute to the nearest office location is more than 50 miles
• Candidate must show exemplary productivity and performance
• Candidate must report to the closest office as needed for personnel meetings and training and/or as supervisor requests (at a minimum, once a month).
• Live in a location that can receive an approved high speed internet connection
• Have a “meets” or “exceeds” performance rating on most current performance review and currently meeting all performance expectations.
• Employee must not have an open Corrective Action Plan.

Under close supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers’ compensation fee schedule by performing the following duties.

Essential Duties and Responsibilities:

• Must be able to process all clients’ bills to serve as a team backup for all clients.
• Must be able to serve as a backup to the Bill Review Supervisor in day to day operations.
• Non-exempt employees must log all time worked in the Paylocity system including log-in and log-off time as well as lunch time.
• Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output.
• Performs preliminary screening for appropriateness and medical necessity of services rendered.
• Uses CPT and ICD-10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational.
• Flags any problem bills.
• Communicates with clients and/or providers to clarify information
• Assists with bill review reporting functions (internal and external reports)
• May specialize in state specific or client specific areas of responsibility
• May assist is answering provider calls.
• May travel to other offices to assist with training
• May be called upon to assist with sales and marketing presentations

Requirements

Competency:

To perform the job successfully, an individual should demonstrate the following competencies:

• Design - Demonstrates attention to detail.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions.
• Team Work - Supports everyone's efforts to succeed.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickl

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent oral and written communication skills.

Education and/or Experience:

High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers’ comp environment.