Sedgwick’s bill review services are part of a customized solution for clients that ensures medical bills are paid timely and at the appropriate cost. Our utilization review (UR) nurses and bill reviewers look for all possible savings and use the most accurate re-pricing system available to make sure bills are paid appropriately based on state rules and regulations, UR treatment plans, clinical edits and other applicable reductions.
PRIMARY PURPOSE: To coordinate program functions and activities as directed by departmental management.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Coordinates workload coverage for vacations, illness, and leave of absence.
- Coordinates special projects ensuring compliance with benchmarks and deadlines.
- Processes employee bills.
- Works closely with other departments ensuring client needs, incentives and contractual requirements are being met.
- Coordinates departmental training needs.
- Reviews policy and procedure changes and addresses with staff.
- Provides tracking reports to upper management; maintains updated staffing lists.
- Participates in meetings as requested by management.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization’s quality program(s).
QUALIFICATIONS
Education & Licensing
High School diploma or GED required.
Experience
Two (2) years bill review experience or equivalent combination of experience and education required.
Skills & Knowledge
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Good organizational skills
- Good interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking