Medical Bill Reviewer I
About The Position
Join our Medical Bill Review team to ensure accurate processing of wage loss and medical claims using applicable laws; manage routine bills and escalate complex issues. This position will be staffed out of our Stevens Point, WI office and is NOT available for remote work. As a Medical Bill Reviewer I, you will review and evaluate medical, dental, and pharmacy bills in accordance with state regulations and established guidelines. You will evaluate bill data in compliance with medical bill processing guidelines, identify errors, and make corrections when possible. You will determine the completeness of a bill and evaluate whether it can be sent back to the provider for required information. You will complete and submit state-mandated forms regarding bill review reductions and/or denials. Additionally, you will review and issue payment of vendor bills related to claim handling, which may include bills for mileage, copy service, court reporters, IME, surveillance, non-emergency transportation, interpreter, utilization review, non-medical consulting, nurse case manager, etc. You will use state reference guides and websites, medical bill coding reference material, and rules built into the bill paying system to determine appropriate resolution and payment. You will also research and analyze provider NPIs/license numbers. You will respond to inquiries from medical providers, attorneys, insured, claimants, and other internal company employees regarding payment for services provided. You may communicate with medical providers regarding payment or denial of payment.
Requirements
- Technical Degree or equivalent work experience
- Technical diploma or Associate Degree in Health Informatics/Health Information/Medical Coding preferred
- High level of communication, customer services and telephone skills required
- 1 or more years of related work experience in a medical office, insurance environment, or medical coding beneficial
- Basic knowledge of ICD9/IDC10, CPT, HCPCS codes necessary for accurate processing
- PC knowledge including Excel as well as keyboarding, math aptitude, and organizational skills
- Proficient analytical and decision making skills with the ability to work independently
- Ability to work within deadlines, maintain confidentiality, and work with detail and a high level of accuracy is essential
Responsibilities
- Review, and evaluate in accordance with state regulations and established guidelines, processes original medical, dental, and pharmacy bills.
- Evaluate bill data in compliance with medical bill processing guidelines.
- Identifies errors and makes corrections when possible.
- Determines the completeness of a bill and evaluates whether the bill can be sent back to the provider for required information in accordance with state guidelines.
- Complete and submit state mandated forms regarding bill review reductions and//or denials in accordance with jurisdictional requirements.
- Review and issue payment of vendor bills related to claim handling which may include bills for mileage, copy service, court reporters, IME, surveillance, non-emergency transportation, interpreter, utilization review, non-medical consulting, nurse case manager, etc.
- Use state reference guides and websites, medical bill coding reference material, and rules built into the bill paying system to determine appropriate resolution and payment of billed item.
- Researches and analyzes provider NPIs/license numbers.
- Responds to inquiries from, medical providers, attorneys, insured, claimants, and other internal company employees regarding payment for services provided.
- May communicate with medical providers regarding payment or denial of payment.
Benefits
- Scheduled Hybrid work model
- In-office workspace and materials for home office
- Equipment for home office
- Meal Subsidy
- 401(K) plan with a dollar for dollar match on your first eight percent, plus immediate vesting
- Sentry University (SentryU)
- Tuition Reimbursement program
- Generous Paid-Time Off plan
- Volunteer-Time off
- Group Medical, Dental, Vision, Life insurance
- Parental leave
- Health and Wellness benefits
- Well-being and Employee Assistance programs
- Sentry Foundation gift matching program
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
