Medical Bill Review II, Support

AmTrust Financial Services•Dallas, TX

17h•Hybrid

About The Position

Overview The Medical Bill Review Support Analyst supports the Medical Management department's key goals of enhancing cost containment. Provides strategic and technical bill review to assist claim offices and adjusters. Accomplishes Managed Care objectives by working processes; planning and evaluating adjuster activities and Medical bill review activities. Technical abilities and industry-specific knowledge to review Workers Compensation medical bills. This role is hybrid out of our Dallas, TX, Jersey City, NJ, or Alpharetta GA office Responsibilities Plan, execute, and oversee bill audits related to state fee disputes. Assist in the development of fee dispute processes, including overall management and monitoring programs. Perform fee dispute reviews and submit relevant formwork related to re-pricing and network vendors. Review and audit bills to verify correct billing practices and contractual rates. Ongoing development of cost containment strategies in response to noted billing practices. Responsible for all financial recovery and reporting of cost savings. Track financial recovery and report cost savings. Perform a wide range of administrative duties related to the quality control and quality assurance of processes. Develop or update procedures for capture, investigation, and documentation of product complaints. Monitor risk-management procedures, maintain problem logs, and report issues to managers and product developers. Prepare written communications such as letters, memos, and emails. Maintain and develop relationships with both internal claims staff and external bill pricing vendors to achieve goals Develop and manage agendas for internal claim office meetings related to fee disputes. Involvement in training material and deliver trainings. Track and promptly investigate material issues, particularly those with a significant impact on the company's financial, operational, and reputational standing. Excellent analytical, problem-solving, and decision-making skills. Review, tabulate, and enter data into a variety of systems. Develop charts, graphs, and tables in Excel and PowerPoint. Analyze and report new or recurring problems in workflows. Manage trends across various areas and document issues to detail areas for workflow improvement. The expected salary range for this role is $61,500.00-$70,000/Yr. Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations. This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time.

Requirements

Bachelor's Degree or equivalent experience
2 or more years of claims experience in positions of increasing responsibility
Knowledge of Workers Compensation Fee Schedule Guidelines, Medical Billing, and Medical Terminology
Experience in bill processing platforms and claim systems
Excellent verbal and written communication skills
Excellent computer skills required including Excel, Access, Outlook, Word and other pertinent computer software packages.
Able to work independently
Commitment to a high level of customer service

Nice To Haves

Working knowledge of medical jargon and anatomy preferred

Responsibilities

Plan, execute, and oversee bill audits related to state fee disputes.
Assist in the development of fee dispute processes, including overall management and monitoring programs.
Perform fee dispute reviews and submit relevant formwork related to re-pricing and network vendors.
Review and audit bills to verify correct billing practices and contractual rates.
Ongoing development of cost containment strategies in response to noted billing practices.
Responsible for all financial recovery and reporting of cost savings.
Track financial recovery and report cost savings.
Perform a wide range of administrative duties related to the quality control and quality assurance of processes.
Develop or update procedures for capture, investigation, and documentation of product complaints.
Monitor risk-management procedures, maintain problem logs, and report issues to managers and product developers.
Prepare written communications such as letters, memos, and emails.
Maintain and develop relationships with both internal claims staff and external bill pricing vendors to achieve goals
Develop and manage agendas for internal claim office meetings related to fee disputes.
Involvement in training material and deliver trainings.
Track and promptly investigate material issues, particularly those with a significant impact on the company's financial, operational, and reputational standing.
Excellent analytical, problem-solving, and decision-making skills.
Review, tabulate, and enter data into a variety of systems.
Develop charts, graphs, and tables in Excel and PowerPoint.
Analyze and report new or recurring problems in workflows.
Manage trends across various areas and document issues to detail areas for workflow improvement.