Bill Reviewer III

Job description

Description Summary: Under limited 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. Competency: To perform the job successfully, an individual should demonstrate the following competencies: - 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 ICD9/ICD10 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 to the BR supervisor. - Communicates with clients and/or providers to clarify information. - Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers. - Ability to price hospital and surgery bills to applicable fee schedules. - Ability to process reconsideration requests as assigned. - May specialize in state specific or client specific areas of responsibility. - May...