Medical Bill Reviewer

Summit Insurance Group, Inc. • Lakeland, FL

6d • Hybrid

About The Position

Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers’ comp, we strive to provide an atmosphere of constant growth and development for our employees. Summit provides workers’ compensation programs and services to thousands of employers throughout the Southeast. Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it’s underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise. At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best. It’s one thing to know workers’ comp. It’s another to know people. But knowing both? That creates an altogether different experience. So, if you’re ready for an altogether different workplace experience, get to know the people who know workers’ comp. Apply today. Essential Job Functions and Responsibilities Reviews and processes medical bills for workers' compensation claims, ensuring accuracy and compliance with company policies and regulatory requirements. Determines the validity of medical bills by cross-referencing with claim details and medical records. Assists with reconciling billing discrepancies and resolving issues with medical providers and claimants. Ensures all billing practices comply with state and federal regulations, including HIPAA and workers' compensation laws. Provides support to claimants and medical providers. Assists with addressing inquiries and resolving billing disputes. Maintains accurate and up-to-date records of all billing activities and communications. Generates reports on billing activities. Participates in collaborating with claims representatives, medical providers, and other internal departments to ensure seamless processing of medical bills. Assists in identifying training issues and may assist with providing training to processors. Performs other duties as assigned. The person hired for this position will work out of the Lakeland, FL office which offers a hybrid work environment of 4 days in the office and 1 day work from home. #LI-Hybrid

Requirements

• High School Diploma or equivalent.
• Generally, a minimum of 3 years of experience in medical billing.
• Proficiency in medical terminology and billing software.
• High attention to detail and accuracy.
• Knowledge of insurance billing policies and third-party payers.

Nice To Haves

• Completion of or continuing progress toward a medical billing and coding designation preferred, such as Certified Professional Coder (CPC) or Certified Coding Specialist – Physician-based (CCS-P).

Responsibilities

• Reviews and processes medical bills for workers' compensation claims, ensuring accuracy and compliance with company policies and regulatory requirements.
• Determines the validity of medical bills by cross-referencing with claim details and medical records.
• Assists with reconciling billing discrepancies and resolving issues with medical providers and claimants.
• Ensures all billing practices comply with state and federal regulations, including HIPAA and workers' compensation laws.
• Provides support to claimants and medical providers.
• Assists with addressing inquiries and resolving billing disputes.
• Maintains accurate and up-to-date records of all billing activities and communications.
• Generates reports on billing activities.
• Participates in collaborating with claims representatives, medical providers, and other internal departments to ensure seamless processing of medical bills.
• Assists in identifying training issues and may assist with providing training to processors.
• Performs other duties as assigned.

Benefits

• We offer competitive benefits packages for full-time and part-time employees.
• Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement.
• Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.
• Compensation varies by role, level, and location and is influenced by skills, experience, and business needs.
• Your recruiter will provide details about benefits and specific compensation ranges during the hiring process.
• Learn more at http://www.gaig.com/careers.
• Excludes seasonal employees and interns.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED