About this role
Role Overview
- Reviews medical bills and documentation according to guidelines and RW policies and procedures.
- Determines if treatment is related and necessary to the covered injury.
- Advises reimbursement recommendations are appropriate.
- Assesses appropriateness and duration of care provided, for possible utilization review.
- Acts as a resource to other staff members to facilitate completion of a quality product.
Requirements
- 1+ years E&M Experience required
- Certified Professional Coder – a plus but not required
- 1+ years medical coding experience – CPT, ICD-10
- preferred
- 1+ years’ experience in Medical Bill Repricing – preferred
- Medicare knowledge
- preferred.
- Ability to apply clinical knowledge and/or coding expertise in bill review.
- Ability to read, write, speak, and understand English well.
- Strong verbal and interpersonal skills.
- Ability to sit for long periods at a computer terminal.
Benefits
- Customer service to adjusters, providers, and claimants regarding bill review.
- Recommendations for independent medical evaluations (IME) to adjusters when necessary.
- Professional knowledge and clinical experience in bill review.