The Reny Company's bill reviewer is a professional who combines experience in health insurance and medical billing with business insight and a passion for great service. Purpose of this role is to support the claims department by analyzing medical, hospital, durable medical equipment, pharmacy, home health, etc. bills and records/reports to determine billing accuracy and appropriateness. The Bill Review Analyst is responsible for reviewing and reducing medical bills per the appropriate state Workers’ Compensation Claims guidelines. This support is achieved by utilizing intelligent software and by understanding and applying knowledge of medical code billing and claims processing rules and regulations, billing practices, code sets, and state and Medicare adjustment reimbursement principles. Support is also achieved by providing education and training regarding provider billing and documentation, identifying and bringing to management's attention any unusual or emerging procedures or billing anomalies. The bill reviewer will ensure the highest level of accuracy of data entry into our bill review system for claims processing.
PLEASE DO NOT APPLY IF YOU DON'T HAVE THE EDUCATION AND MEDICAL BILL REVIEW EXPERIENCE
Experience Requirements:
Two or more years of experience in a medical coding role preferred. Specific experience working with claims data and analysis especially in cost and utilization analysis is highly desirable as well as experience analyzing commercial, Medicare and/or Medicaid medical, dental and/or behavioral health claims.Working knowledge of industry coding (revenue codes, ICD classifications, CPT codes, etc.
A working knowledge of healthcare industry terms such as HL7, PHI, HIPAA, HITECH, etc.
Prior experience in a payer environment working with claims systems and bill review software is a plus.
Responsibilities:
- Process medical bills for workers' compensation, Texas non subscription, maritime, occupational accident, and liability claims
- Data entry into system applying usual and customary, worker's compensation and liability ground rules and fee schedules
- Continuous enhancement of working knowledge of medical forms such as CMS-1500, UB-92, Pharmacy, Dental
- Increase knowledge of coding principles CPT, ICD-9 / ICD-10, DRG, Revenue codes
- Responsible for processing a minimum quota per day with an error rate of 98% or better
- Increase knowledge on preauthorization guidelines in order to pay/deny bills accordingly
- Ensure all bill processing is specific to client requests
- May be asked to perform other duties as management deems necessary
Education/Qualifications:
Associates degree or equivalent work experience Certified Professional Coder certification such as CCA. CCS, CCS-P, CPC, CPC-P from a generally recognized professional organization such as AHIMA or AAPC.
Must be able to process daily quota of bills as assigned by Team Lead and/or Bill Review Manager. Strong data analysis skills and good decision making ability.Maintains a high degree of accuracy. Requires strong verbal and written communications skills to answer emails and calls from clients, providers and staff regarding assigned accounts.Requires good follow through skills.
Remains current on changes that occur with CPT, ICD and revenue codes as it pertains to assigned accounts. Ability to multi-task and work with little direction; strong prioritization and time management skills. Self-motivated to keep up with production requirements.
- High school diploma or equivalent, college preferred
- Two to three years of medical claims experience
- Trained in ICD10 preferred
- Workers’ Compensation experience preferred
- Fee Schedule knowledge and Medicare experience preferred
- Knowledgeable of Excel, Word, Outlook, etc.
- Ability to multi-task effectively while meeting or exceeding aggressive deadlines
- Ability to work independently and in a team environment
ONLY THOSE WITH RELEVANT EDUCATION AND MEDICAL BILL REVIEW EXPERIENCE NEED APPLY
Job Type: Full-time
Pay: $21.00 - $26.00 per hour
Expected hours: 40 – 45 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
Experience:
- medical claims: 4 years (Preferred)
- billing: 4 years (Preferred)
Education:
Work Location: In person