Bill Review Specialist - Workers Compensation - REMOTE

EK Health Services•Phoenix, AZ

22h•Remote

About The Position

The Bill Review Specialist accurately analyzes and processes large, complex workers’ compensation medical bills and makes payment recommendations. Reviews consider claim history, medical notes, usual and customary rates, statutory regulations and state fee schedules, available MPN/PPO contracts, coding guidelines, client instructions, and company policies and procedures. The role also verifies medical billing codes, supports quality assurance from bill receipt through final payment, protects system integrity, communicates with providers and clients, and participates in ongoing training. This is a full-time, non-exempt remote position, Monday through Friday, 7 a.m.–4 p.m. local time. Applicants residing in California, New York, or Hawaii are not being considered.

Requirements

High school diploma required.
At least 2 years of experience in complex Workers’ Compensation Bill Review with customer service exposure.
Knowledge of medical terminology, CPT codes, and DRG.
Ability to read, analyze, and interpret technical procedures, medical reports, state laws, and fee schedules.
Excellent written and oral communication and interpersonal skills.
Strong organizational skills.
Comfort using computers and programs such as MS Word, MS Excel, and email.
Ability to meet deadlines in a high-pressure, time-sensitive environment.
Ability to lift up to 20 pounds.
Ability to sit and keyboard for the majority of an 8-hour day, except for lunch and break times; manual dexterity; and ability to speak on the telephone intermittently throughout the day.
Ability to read and write English fluently and provide and confirm a safe home office environment.
Home office must be HIPAA compliant, with DSL, fiber, or cable internet; 100 Mbps or better is preferred.

Nice To Haves

Some college or a college degree.
Hospital Bill Review experience.
CPC (Certified Professional Coding) coursework or certification.

Responsibilities

Analyze complex medical bills and make payment recommendations using claim history, medical notes, usual and customary rates, laws and fee schedules, contracts, coding guidelines, client instructions, and company policies.
Review and verify the correct use of medical billing codes and report improper coding to the Bill Review Manager.
Participate in quality assurance from initial receipt of bills through final payment.
Monitor and correct duplicate entries and inaccurate or outdated data to protect system integrity.
Communicate with medical providers to obtain information and resolve bill-specific issues.
Respond to client questions quickly and professionally, providing excellent customer service.
Participate in ongoing training to enhance job skills and knowledge.
Perform other duties as assigned.