Medical Bill Adjuster

Encova•Charleston, WV

3d•Hybrid

About The Position

Encova Insurance is seeking a Medical Bill Adjuster. The ideal candidate will reside within a reasonable commuting distance of our Charleston, West Virginia office and be able to work a hybrid schedule. However, we are also open to highly qualified candidates who reside in any state where Encova is authorized to employ associates, as listed in this posting, and who wish to work remotely from a home-based office. The Medical Bill Adjuster researches, audits and processes moderately complex to complex medical bills for payment. This position determines the appropriateness of procedural coding, diagnosis and services that require prior approval. The Medical Bill Adjuster processes bills for all locations in which Encova Insurance conducts business.

Requirements

A minimum of three years of experience in medical coding or medical bill processing is required.
Strong attention to detail.
Extensive knowledge of medical billing, ICD-10, CPT-4, DRG and HCPCS coding.
Comprehensive understanding of medical invoices and forms.
Effective computer skills.
Ability to effectively prioritize and carry out work assignments.
Strong computer skills.
Strong communication skills.
Ability to use and apply basic math skills.
Understanding of Preferred Provider Organization (PPO).
Extensive knowledge of medical terminology.
Excellent data entry skills.

Nice To Haves

Associate or bachelor’s degree from an accredited college or university is strongly preferred; commensurate experience may be considered.
Certification in medical coding from either AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association) is strongly preferred.

Responsibilities

Process medical invoices based on a pre-determined quota.
Ensure bills are related to compensable injury.
Research medical records to determine appropriate coding.
Audit and process inpatient hospital bills.
Audit and process higher-dollar claims.
Audit high-level evaluation and management bills for appropriate billing.
Review invoices for correct coding and correct usage of modifiers.
Approve additional units for payment for certain CPT/HCPCS codes.
Discuss billing matters with medical providers, claims adjuster, and customers.
Identify vendor trends and training needs and make recommendations accordingly.
Prepare reports and compile comprehensive data relating to the vendor review unit.
Analyze and manipulate report data.
Consult as needed with other staff regarding training needs.
Perform system testing as needed.