Bill Reviewer III

Intercare Holdings Insurance Services•Rocklin, CA

11d•Remote

About The Position

Summary: Employee will work 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. This position may be considered to work from home under the following criteria: 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. 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

Requirements

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

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.
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