Bill Reviewer Iii - Orange, United States - Intercare Holdings Insurance Services

Intercare Holdings Insurance Services

Verified Company

Orange, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

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:

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.
Nonexempt employees must log all time worked in the Paylocity system including login and logoff 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 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.
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.