Bill Specialist I

Job Description

• A high school diploma or equivalent work experience is required.
• Minimum of 2 or more years work experience demonstrating knowledge and use of CPT and ICD-9 codes and medical terminology in bill or claims processing environment.
• ading comprehension skills and strong verbal and written communication skills are required as well as typing speed of 20 WPM and 8,500 numeric keystrokes per hour. Familiarity with HFCA and UB92 forms and windows environment. Must be able to work in a fast-paced team environment, meet deadlines, achieve quality and production standards, problem solve and make decisions based on standard policies and procedures.

Responsibilities

• Access and verify claim numbers in multiple claim systems, review file notes and the Claim Summary Windows and identify the correct claim number and claim.
• Review and interpret procedure codes (CPT), diagnosis codes (ICD-9), and nature of injury as indicated in the claim system to determine medical causality. Research claim information and authorize/pend bill for payment.
• Document reasons for pending bills to the BCO or provider and indicate any specific jurisdictional requirements, indication of fraud, or further information needed for bill processing. Communicate to Supervisor any pertinent information (i.e. discrepancies found in files, etc) to ensure an accurate and productive working environment.
• Identify employee and health privacy indicated claims and forward accordingly for appropriate processing.
• Utilize internal forms and notes to communicate findings to Branch Claims Offices and providers. May maintain verbal communication to collect facts and provide information relating to the processing of the bill.
• Access bill classification information to change Broadspire receipt date and account (BCO) receipt date.
• Utilize windows to view and interpret images of bills and reports. Enter information required to complete bill adjudication. Apply bill/form types and research codes. Research bills returned from the Branch Claims Offices and Providers.
• Assign resolution codes to complete bill processing.
• Meet required Quality/Production Standards while maintaining turnaround on assigned states. Ensure accurate and efficient processing; accurately report bills processed daily.
• May perform other duties as assigned.

Qualifications

• A high school diploma or equivalent work experience is required.
• Minimum of 2 or more years work experience demonstrating knowledge and use of CPT and ICD-9 codes and medical terminology in bill or claims processing environment.
• Adding comprehension skills and strong verbal and written communication skills are required as well as typing speed of 20 WPM and 8,500 numeric keystrokes per hour. Familiarity with HFCA and UB92 forms and windows environment. Must be able to work in a fast-paced team environment, meet deadlines, achieve quality and production standards, problem solve and make decisions based on standard policies and procedures.

About Us

Why Crawford?

Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time.

At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us.

We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com .

When you accept a job with Crawford, you become a part of the One Crawford family.

Our total compensation plans provide each of our employees with far more than just a great salary

• Pay and incentive plans that recognize performance excellence
• Benefit programs that empower financial, physical, and mental wellness
• Training programs that promote continuous learning and career progression while enhancing job performance
• Sustainability programs that give back to the communities in which we live and work
• A culture of respect, collaboration, entrepreneurial spirit and inclusion

Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.