Serve as a subject-matter expert for Medical Bill Review (MBR) operations;
Provide advanced production support and drive process improvements;
Coordinate cross-functional issue resolution and project execution;
Support processing of workers’ compensation medical and pharmacy bills from bill intake through payment;
Investigate bill processing issues and problem-solve;
Interface with multiple vendors for issue resolution;
Monitor business dashboards and vendor reports daily for TAT trends;
Recommend workflow enhancements and document trends and issues for improvement;
Build and maintain relationships with internal teams, external vendors, and medical providers.

MBR business process SME including experience with MBR E2E process from a business/operations perspective;
firm understanding of integrated services and workflows including FS/UCR, Nurse and code review, PPO, negotiations, adjustor bill adjudication;
workers compensation regulatory environment experience/understanding;
Demonstrated application of successful critical thinking and complex problem solving skills;
Experience in a role requiring deep understanding of and experience working with MBR and integrated services technology;
Experience gathering business requirements and clearly documenting complex scenarios and use cases;
Communication experience with varied audiences including leadership and peers in business/operational & technology roles;
Client-facing acumen;
Team-player;
Experience with Atlassian/JIRA/SQL.
5 years in a multi-faceted workers compensation MBR role demonstrating increasing responsibility with required skills outlined above within that time or 3 years in an MBR role + 2 years in position with similar responsibilities.

Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.

Workers Compensation, Medical Bill Review, Operations Analyst

Key skills