What are the responsibilities and job description for the Senior Medical Services Representative position at Liberty Mutual Insurance Group?
Audit medical bills for relatedness and appropriateness for WC or Auto claims, using critical thinking skills to make accurate, timely, and compliant payment decisions while meeting production requirements Identifies and resolves discrepancies in transactions/documents reviewed. Refers difficult or questionable transactions to Supervisor for assistance in resolution. Maintains appropriate transaction records and generates activity reports. Provides guidance and assistance to internal customers, providers, claimants, and/or policyholders on inquiries and problems and explains processing procedures, etc. Maintains relationships with internal and/or external customers and providers to ensure timely processing of transactions. Responds to customer/provider inquiries and creates and issues provider correspondence. Communicates with claims professionals, attorneys, and others to gather necessary information in order to complete transactions. Knowledge of medical terminology, medical coding Intermediate to advanced knowledge of Current Procedural Terminology (CPT), International Classification of Disease (ICD), and Health Care Common Procedure Coding System (HCPCS) coding, various jurisdictional fees schedule methodologies and expertise; and support dispute management In-depth knowledge of state regulatory requirements Good oral and written communication skills to effectively maintain customer service relations Strong data entry skills needed for fast paced environment Ability to independently and effectively manage issues such as complex processing/transaction issues, medical provider complaints, etc Knowledge, skills and other capabilities normally acquired through a high school diploma (or equivalent), plus 1-2 years work-related experience