Analyst

Zenith Insurance Company•Los Angeles, CA

12d

About The Position

Under general supervision, the Analyst will be responsible to analyze, audit, review and/or make corrections to medical bills from providers to determine the appropriate reimbursement.

Requirements

High School Diploma or equivalent combination of education and experience required
1-3 years medical bill review (or related) experience, in Workers Compensation, Medical/Health Care, Insurance Industry or Medical Coding/Billing. Work experience demonstrating knowledge of ICD-10 classifications, CPT codes, HCPCS, Workers' Compensation State Fee Schedules and/or Medicare knowledge required.
Demonstrated knowledge of medical terminology, anatomy and surgical/medical procedure terms.
Demonstrated proficiency with billing software, technology and system driven workflows.
Demonstrated familiarity with a broad type of medical billing forms.
Ability to interpret medical records to support the appropriate billed services.
Strong verbal and written communication skills.
Ability to work with little direction and maintain long periods of focused concentration.
Strong prioritization and time management skills.
Flexible and adaptable to a growing and changing environment.
All candidates must meet; or be able to obtain, as set forth within the statutory requirement, all state regulatory standards regarding certification, licensing, designation and continuing education requirements.

Nice To Haves

Bachelor’s Degree or equivalent combination of education and experience preferred

Responsibilities

Reviews Workers’ Compensation medical bills to ensure accurate and appropriate payment recommendations, according to State Fee schedules, guidelines and PPO Network pricing.
Approves, modifies, and/or denies bills in accordance with state mandates and/or department guidelines.
Reviews and interprets supporting documentation attached to medical billings, including review of claim information, to determine appropriate reimbursement.
Audits and certifies potential duplicate bills and determines previous status of processing through close review and search of medical bills in the bill review system.
Confirms and applies utilization review determinations as part of medical bill reviews when applicable.
Determines and forwards bills to the MAT team that may be eligible for provider negotiations based on evaluation of billed services, pricing, and payment guidelines.
Manages a bill processing assignment, which includes initial billing submissions. Tracks issues and trends.
Occasionally processes bills requiring a secondary review, such as those submitted through the formal reconsideration process.
Participates and completes required training to enhance the proficiency in bill review and processing.
Communicates any system, bill review, billing anomaly and procedural issues to departmental supervisor.
Meets established production and quality goals.
Responds positively to direction and feedback on performance.
Works productively and harmoniously with others on a consistent basis.
Consistently maintains professional and appropriate demeanor.
Performs other job related duties as assigned.