Bill Review Complex Analyst, Risk Management - Lakeland

Publix • Lakeland, FL

1d • Onsite

About The Position

The purpose of this position is to analyze and review medical bills for adjudication of invoices for Publix associates injured in Workers Compensation accidents. The Bill Review Analyst is responsible for ensuring bills are paid in a timely manner and in accordance with the Workers Compensation laws of the states in which Publix does business in.

Requirements

• Associate’s degree
• 1-year general office with experience with Windows based programs
• National Certification for CPT Coding
• Knowledge of CPT and ICD-9 codes
• Knowledge of multiple state Worker’s Compensation Fee Schedules for the states in which Publix does business in
• Knowledge of Medical Terminology
• Initiative
• Planning and Organizing
• Stress-Tolerance
• Time Management
• Financial Acumen
• Detail Orientation
• Problem Solving
• Building Relationships
• Customer Focus
• Verbal Communication
• Written Communication
• Microsoft Word (Basic)
• Microsoft Excel (Basic)
• Microsoft PowerPoint (Basic)
• Microsoft Access (Basic)

Nice To Haves

• BS degree or certificate of completion of a medical terminology or medical billing program
• 1 year in medical or insurance services, with advanced knowledge of CPT and ICD-9 codes, and knowledge of medical terminology
• National Certification for CPT Coding
• Bilingual in English and Spanish
• Microsoft Word (Expert)
• Microsoft Excel (Advanced)
• Microsoft PowerPoint (Intermediate)
• Microsoft Access (Advanced)
• SmartAdvisor/CEPV ODG Mitchell and RMX software systems, or similar bill review software

Responsibilities

• Reviewing and analyzing medical bills to confirm whether treatment rendered was authorized by the adjuster or medical case manager is appropriate for the type of injury sustained, and that the fees invoiced are standard and equitable, follow appropriate schedules and regulations, and align with previous contracted agreements.
• Manually reviewing and resolving issues on medical bills that are flagged as requiring more in-depth review, or which cannot otherwise be re-priced to the appropriate state workers’ compensation fee schedule by our automated medical bill review system (Smart Advisor).
• Communicating directly with vendors and medical providers that challenge the amount reimbursed.
• Administering disputes regarding medical billings in accordance with the appropriate state mandated “Reconsideration Process,” as required by each individual state’s workers’ compensation rules and regulations, which contains stringent timelines. These challenges are typically received via telephone, fax, or in writing.
• Providing customer service activities to providers, Publix managers, and associates that contact Risk Management regarding the payment or non-payment of bills.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree