Bill Review Analyst, you would be responsible for identifying unbundled charges and billing errors through pre-screening of claims. Your findings will be used by our negotiation team to help them achieve better results during the negotiation process. You will also carry out in-depth reviews based on accepted billing practices and coding rules.
To achieve the best results, you will need to maintain excellent communication with both internal teams and management. Your efforts will result in significant savings for our clients.
Are you looking for a new challenge and the chance to develop your skills? Apply now and don’t miss out on this exciting opportunity!
DUTIES AND RESPONSIBILITIES:
- Identifies correct billing and savings on claims by running the codes through the system programs.
- Performs research on fee schedule states in the auditing process.
- Maintains a functional understanding of Workers’ Compensation state fee schedules, billing and coding rules and state specific provider payment regulations.
- Works collaboratively with the Negotiations team to resolve claim issues and obtain additional discount.
- Assists the Negotiation team with provider communication, obtaining a corrected claim or letter of agreement, based on audit findings and financial benchmarks.
- Communicates all findings to the Negotiation team by providing a Bill Analysis report/email.
- Communicates with the negotiation team, to query or to resolve billing discrepancies.
- Maintains a consistent department bill review prescreen turnaround time. Standard TAT for Bill Analyst prescreen 24-48 hours from UB/IB receipt.
- Complies with/supports HIPAA standards.
- Identifies system/process issues and seeks interdepartmental resolutions.
- Understanding of medical terminology and guidelines for medical services, charges, etc.; ability to read and understand medical bills and records.
- Ability to collect and organize data, identify and define issues, organize and communicate facts using concise business writing.
- Ability to make prompt, intelligent decisions based upon detailed analysis of issues including accurate and valid conclusions.
- Ability to handle a variety of instructions and priorities.
OTHER DUTIES:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
POSITION REQUIREMENTS:
- Great Attention to Detail is a must.
- Excellent Organization Skills.
- Must be able to work independently.
- Excellent communication skills, both verbal and written.
- Dependability
- 1-3 years of auditing, claims, review and/or billing experience with a healthcare organization required. Workers’ Compensation experience preferred.
- Bill and concurrent review experience.
- DRG Validation experience.
- Line Charge Verification experience.
- CPC and CIC certifications preferred.
- Working knowledge of industry coding, ICD-10, CPT, HCPCS Revenue codes etc.
- Has experience with Microsoft Office applications.
- Working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
- Knowledge of CMS guidelines.
Benefits:
- Medical, Rx, and Wellness Benefits
- Dental and Vision Plan Options
- Short-term Disability
- 401(k) Retirement Plan
- Holiday Pay
Compensation / Pay Rate (Up to): $60,000.00 – $65,000.00 Per Year
