Medical Bill Coordinator - Remote

Sedgwick

2d•Remote

About The Position

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Medical Bill Coordinator - Remote PRIMARY PURPOSE: To review hospital and professional medical bills from provider including complex hospital, surgical, high level evaluation and management codes, and/or technical bills. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Processes bills in accordance with multi state schedules, rules, regulations, and guidelines. Applies PPO contract discounts to bills. Reviews operative reports to determine if surgery services were appropriately billed. Reviews complex medical, legal and consult services. Contacts client or facility to obtain additional or missing information. Handles provider appeals where appropriate to fee schedule and contractual disputes. Communicates internal issues to management. Assists bill review team lead with workflow management, coaching and mentoring of staff. Assists with process, procedure and system training for new staff. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travel as required. QUALIFICATIONS Education & Licensing High School diploma or GED required. Experience Two (2) years workers' compensation and/or bill review experience or equivalent combination of education and experience required to include provider appeals experience. PPO re-pricing, surgery review, by report and RNE review preferred. Two (2) years of experience with complex medical, legal, and consult review preferred. Skills & Knowledge Knowledge of re-pricing rules and guidelines Knowledge of medical terminology, anatomy and surgical terms Knowledge of multiple state jurisdictional regulations and rules Knowledge of Fee Schedules, Rules, and U&C Guidelines Knowledge of CPT/ICD9 PC literate, including Microsoft Office products Leadership skills and ability to motivate others Strong verbal and written communication skills Strong interpersonal skills High level of accuracy and attention to detail Ability to multi-task and function in high volume area Ability to handle deadlines and proactively problem solve Ability to work in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding, travel as required Auditory/Visual: Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles. Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com

Requirements

High School diploma or GED required.
Two (2) years workers' compensation and/or bill review experience or equivalent combination of education and experience required to include provider appeals experience.
Knowledge of re-pricing rules and guidelines
Knowledge of medical terminology, anatomy and surgical terms
Knowledge of multiple state jurisdictional regulations and rules
Knowledge of Fee Schedules, Rules, and U&C Guidelines
Knowledge of CPT/ICD9
PC literate, including Microsoft Office products
Leadership skills and ability to motivate others
Strong verbal and written communication skills
Strong interpersonal skills
High level of accuracy and attention to detail
Ability to multi-task and function in high volume area
Ability to handle deadlines and proactively problem solve
Ability to work in a team environment
Ability to meet or exceed Performance Competencies

Nice To Haves

PPO re-pricing, surgery review, by report and RNE review preferred.
Two (2) years of experience with complex medical, legal, and consult review preferred.

Responsibilities

Processes bills in accordance with multi state schedules, rules, regulations, and guidelines.
Applies PPO contract discounts to bills.
Reviews operative reports to determine if surgery services were appropriately billed.
Reviews complex medical, legal and consult services.
Contacts client or facility to obtain additional or missing information.
Handles provider appeals where appropriate to fee schedule and contractual disputes.
Communicates internal issues to management.
Assists bill review team lead with workflow management, coaching and mentoring of staff.
Assists with process, procedure and system training for new staff.
Performs other duties as assigned.
Supports the organization's quality program(s).
Travel as required.