Medical Fee Examiner
About The Position
The Medical Fee Examiner works in the Medical Fees Section of the North Carolina Industrial Commission, which reviews and processes bills for medical services in workers’ compensation claims when parties need assistance applying the Commission’s Medical Fee Schedule. The section also responds to medical bill and fee inquiries, maintains and updates the Medical Fee Schedule, and administers the informal phase of the Medical Provider Fee Dispute procedure. The position assists parties with applying the Medical Fee Schedule by repricing bills upon request or advising parties by telephone or email. It maintains the schedule in conjunction with the Executive Secretary and the Commission’s vendor, issues letters about medical bill-related matters, and answers questions about bill processing and coding. The position also processes informal fee dispute requests, gathers information from parties, requests payor responses, conducts telephone conferences to help resolve disputes, and prepares summaries of dispute-resolution efforts when needed. It tracks unit work and supports other duties in the Medical Fees Section and Executive Secretary’s Office. The position currently qualifies for a hybrid telework option with routine office and remote workdays.
Requirements
- High school diploma or GED and four years of experience in a hospital, clinic, insurance company, or private organization involved in determining charges for professional medical services or hospitalization; OR graduation from a state-accredited nursing program, one year of general nursing experience, and one year of experience determining such charges; OR an equivalent combination of education and experience.
- Demonstrated expertise in medical terminology, clinical and surgical procedures, and medical coding, applied to calculating reimbursement according to Medicare and other fee schedules.
- Ability to input data and draft business correspondence accurately and with attention to detail, including modifying correspondence or report templates as needed.
- Experience reviewing and processing information to determine conclusions, actions, or compliance with applicable laws, rules, or regulations.
- Experience independently responding to inquiries and coordinating resources to acquire and disseminate information.
- Experience managing a large number of pending items and assisting in their timely completion.
Nice To Haves
- Experience with Medicare reimbursement methodologies.
Responsibilities
- Assist parties in applying the Commission’s Medical Fee Schedule to workers’ compensation medical bills by repricing bills upon request or advising parties by telephone or email.
- Review draft repricing prepared by a processing assistant in some cases.
- Update and maintain the Medical Fee Schedule annually and as needed, in conjunction with the Executive Secretary and the Commission’s vendor.
- Issue letters to parties regarding medical bill-related issues.
- Advise the public by telephone and email on medical bill processing, coding, and related questions.
- Administer the informal phase of the Health Care Provider Fee Dispute Procedure, including processing requests, repricing bills, contacting parties for information, requesting payor responses, conducting telephone conferences, and preparing summaries of resolution efforts when needed.
- Maintain statistics on the work of the unit.
- Assist with other duties in the Medical Fees Section and Executive Secretary’s Office as needed.
Benefits
- 12 annual paid holidays.
- North Carolina State Health Plan administered by AETNA.
- Supplemental benefits including flexible spending accounts, accident insurance, cancer and specified disease insurance, critical illness insurance, dental insurance, and vision insurance.
- NC State Retirement (TSERS).
- WeSave employee discounts.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
