Job Detail

Summary:

Under close supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers’ compensation fee schedule by performing the following duties.

Essential Duties and Responsibilities:

• Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output.
• Performs preliminary screening for appropriateness and medical necessity of services rendered.
• Uses CPT and ICD-9 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational.
• Flags any problem bills.
• Communicates with clients and/or providers to clarify information
• Forwards to Intermed nurse all multiple surgery bills, and/or unidentifiable unlisted procedure numbers.
• May specialize in state specific or client specific areas of responsibility
• May assist clerical staff in batching incoming mail
• May assist is answering provider calls.

Competency:

To perform the job successfully, an individual should demonstrate the following competencies:

• Design - Demonstrates attention to detail.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions.
• Team Work - Supports everyone's efforts to succeed.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers’ comp environment.