About this role
Role Overview
- The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine relationship of services billed to the covered injury
- Applies appropriate review guidelines, assesses appropriate use of medical coding
- Identifies over-utilization of treatment and makes appropriate reimbursement recommendations
- The incumbent is also responsible for the quality timeliness and customer service for assigned accounts
- 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
- Provides customer service to adjusters, providers, and claimants regarding bill review
- Assesses appropriateness and duration of care provided, for possible utilization review
- Recommends independent medical evaluations (IME) to adjusters when necessary
- Act as a resource to other staff members to facilitate completion of a quality product
- Use appropriate reference material as necessary to perform professional review
- Meets company productivity standards
- Meets company quality standards
Requirements
- 1+ years medical coding experience – CPT, ICD-10
- preferred
- 1+ years’ experience in Medical Bill Repricing – preferred
- Certified Professional Coder – a plus but not required
- StrataCare software
- a plus, but not required
- Ability to apply clinical knowledge and/or coding expertise in bill review
- Ability to read, write, speak, and understand English well
- Ability to understand and follow written and oral instructions
- Possess strong verbal and interpersonal skills
- Ability to multi-task
- Possess problems solving skills
- Ability to sit for long periods at a computer terminal keyboarding
- PC skills – required
- Knowledge of Microsoft Office Products – required
- Ability to operate standard office equipment including telephone