Bill Review Claims Specialist

Bill Review Claims Specialist

About Us:

Managed Care Network, Inc. is a dynamic and growing managed care company committed to creating an exceptional workplace where employees feel valued, supported, and part of a close-knit team. We prioritize a culture of respect, collaboration, and continuous growth, recognizing the expertise and dedication of our staff every day.

Our strong sense of teamwork drives both company and individual success, allowing employees to thrive personally and professionally. Guided by our mission, we build trusted partnerships with our clients by delivering reliable, innovative solutions that make their work easier and more effective.

Job Description:

The Bill Review Department is seeking a motivated, detail-oriented Claims Specialist to support the medical claims review process for Workers’ Compensation and No-Fault insurance cases. This role is ideal for a growth-minded, quality-driven individual with experience in medical billing, fee schedule application, and administrative support who thrives in a fast-paced, collaborative environment.

The Bill Review Claims Specialist plays a vital role in ensuring the accurate intake, review, organization, and documentation of medical bills while supporting communication between internal departments and external partners. This position offers excellent professional growth opportunities within a dynamic and expanding department.

Key Responsibilities

Bill Review & Claims Support

• Review medical bills and supporting documentation for completeness, accuracy, and proper fee schedule application.
• Ensure compliance with New York State Workers’ Compensation and No-Fault billing regulations.
• Perform case and claim reviews to verify documentation supports billed services.
• Identify billing discrepancies and assist in resolving coding, fee schedule, or documentation issues.
• Coordinate and track bill review inventory, claim status, and processing timelines.
• Monitor and prioritize workloads, identifying urgent or high-priority cases to ensure timely completion.

Administrative Support

• Enter, update, and maintain accurate claim and billing information within Strataware and other bill review or managed care platforms.
• Utilize internal systems such as medical servers, databases, eCase, and medical portals to access claim information and support workflow processes.
• Type, scan, process, and organize correspondence, reports, invoices, and related documentation.
• Maintain organized electronic and physical records to support compliance and operational efficiency.
• Provide administrative support across the medical department as needed, including cross-coverage for team functions.

Communication & Collaboration

• Communicate professionally with adjusters, coders, providers, and internal departments to resolve billing or documentation issues.
• Collaborate effectively with team members and leadership to support departmental goals and process improvements.
• Provide excellent internal customer service with professionalism and responsiveness.

Additional Responsibilities

• Assist with special projects as assigned by department leadership.
• Participate in ongoing training and educational opportunities to enhance job knowledge and professional development.
• Adapt to changing priorities and support additional departmental functions when needed.

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Qualifications

Required Skills & Experience

• 1–2 years of medical billing, bill review or similar experience, preferably in Workers’ Compensation, No-Fault or medical environments.
• Experience applying medical fee schedules and reviewing medical bills.
• Working knowledge of New York State Workers’ Compensation and No-Fault billing practices preferred.
• Familiarity with:

o Medical terminology

o CPT, ICD-10, and HCPCS coding

• Strong computer proficiency, including:

o Microsoft Office (Excel, Outlook, Word)

o Bill review software such as Strataware or similar platforms

• Excellent organizational skills and strong attention to detail.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Strong written and verbal communication skills.
• Professional, dependable, and collaborative team player.
• Solution-driven mindset with adaptability and willingness to learn.

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Job Type: Full-Time, non-exempt

Schedule:

• Monday to Friday (In office, with ability to transition to 1-day WFH upon management approval).

Pay: $41,600.00 - $49,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in Grand Island, NY 14072

Salary : $41,600 - $49,000