Job Description

Under limited 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:

• 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 ICD9/ICD10 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 to the BR supervisor.
• Communicates with clients and/or providers to clarify information.
• Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers.
• Ability to price hospital and surgery bills to applicable fee schedules.
• Ability to process reconsideration requests as assigned.
• May specialize in state specific or client specific areas of responsibility.
• May assist is answering provider calls.

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 quickly.

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.

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.

Language Skills:

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Knowledge Skills:

Strong knowledge of CPT and ICD9/ICD10 coding and workers compensation fee schedules. Must be familiar with workers’ compensation regulations and have good comprehension of company software system process.

Math Skills:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability:

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills:

To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software.

Certificates and Licenses:

Must have Medical Bill Reviewer Designation – 40 hour initial certification plus continuing education hours of 16 hours every 2 years.

Supervisory Responsibilities:

This job has no supervisory responsibilities.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work and eight-hour shift, sit for long periods during the day, type or work at a keyboard most of the day, and read a video display terminal for long periods of time.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

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.

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.