Senior Bill Review Services Analyst
This position identifies an individual who has strong technical bill review skills. They have broader and more extensive expanded experience and knowledge in this area. This position will be responsible for reviewing and re-pricing workers' compensation bills including bills considered being to be rated at a higher degree of difficulty.
Responsible for reviewing medical bills - in accordance to the Official Medical Fee Schedule. Must apply Utilization Review (UR) decisions and MPN information to the workers' compensation medical bills. Must be able to review bills for facility charges, surgical bills, ambulance services and med-legal reports; Must take an active role in reviewing appeals/reconsiderations as well as Review Only bills.
Responsible for helping with quality/batch prep reports to ensure accuracy of reviews before they are returned to the file. Must be able to help identify billing issues and be able to help with identifying strategies to address the issues.
Work in close coordination with the Claims Examiner and Utilization Review team for the accurate completion of all bill review actions.
Complete a minimum standard of 200 reviews per day. Claim number and provider information must be checked for accuracy. Application of state guidelines, PPO's and UR decisions to the medical bills.
Act as a resource for the WellComp Service Center Team.
Other duties as assigned
SKILLS/ABILITIES:
Ability to think through processes and documentation
Must be able to take direction and add thought to process
Strong communication and collaborative skills
Strong Organizational and efficiency Skills
Effective and accurate verbal and written skills
KNOWLEDGE:
ADAPTABILITY: Maintain effectiveness when experiencing major changes in work tasks or the work environment. Adjust effectively to work within new structures, processes, requirements or cultures. Able to change priorities to meet multiple deadlines while being responsive to customer needs.
COLLABORATION effectively and cooperate with others. Establish and maintain good work relationships.
COMMUNICATION: Clearly convey information and ideas through a variety of media to individuals or
groups in a manner that engages the audience and helps them understand and retain the message.
CONTRIBUTING TO TEAM SUCCESS: Actively participate as a member of the team to move toward the completion of goals.
CUSTOMER FOCUS: Make customers, and their needs, a primary focus of one's actions. Develop and sustain productive customer relationships.
INITIATING ACTION: Take prompt action to accomplish objectives. Take action to achieve goals beyond what is required, be proactive. Anticipate consequences of decisions and actions.
Communicate recommendations to take preventative steps and initiate further action
MANAGING WORK manages time and resources to ensure that work is completed efficiently.
QUALITY ORIENTATION: Accomplish tasks by considering all areas involved, no matter how small. Show concern for all aspects of the job. Accurately check processes and tasks. Be watchful over time, meet demanding deadlines, learn quickly and exhibit organization in work habits.
STRESS TOLERANCE: Maintain stable performance under pressure or opposition, such as, time pressure or job ambiguity. Handle stress in a way that is acceptable to others and to the organization.
TECHNICAL/PROFESSIONAL KNOWLEDGE AND SKILLS achieve a satisfactory level of technical and professional skills, or knowledge in position related areas. Keep up with current developments and trends in area of expertise. Display a strong work ethic demonstrated in attendance, punctuality, maturity and dedication. Maintain a positive attitude.
EDUCATION:
BS / BA or Equivalent Work Experience
Experience:
3
years of professional work experience
Previous work in medical claims or medical billing
Enter job descriptionEstimated Salary: $20 to $28 per hour based on qualifications.
Responsible for reviewing medical bills - in accordance to the Official Medical Fee Schedule. Must apply Utilization Review (UR) decisions and MPN information to the workers' compensation medical bills. Must be able to review bills for facility charges, surgical bills, ambulance services and med-legal reports; Must take an active role in reviewing appeals/reconsiderations as well as Review Only bills.
Responsible for helping with quality/batch prep reports to ensure accuracy of reviews before they are returned to the file. Must be able to help identify billing issues and be able to help with identifying strategies to address the issues.
Work in close coordination with the Claims Examiner and Utilization Review team for the accurate completion of all bill review actions.
Complete a minimum standard of 200 reviews per day. Claim number and provider information must be checked for accuracy. Application of state guidelines, PPO's and UR decisions to the medical bills.
Act as a resource for the WellComp Service Center Team.
Other duties as assigned
SKILLS/ABILITIES:
Ability to think through processes and documentation
Must be able to take direction and add thought to process
Strong communication and collaborative skills
Strong Organizational and efficiency Skills
Effective and accurate verbal and written skills
KNOWLEDGE:
ADAPTABILITY: Maintain effectiveness when experiencing major changes in work tasks or the work environment. Adjust effectively to work within new structures, processes, requirements or cultures. Able to change priorities to meet multiple deadlines while being responsive to customer needs.
COLLABORATION effectively and cooperate with others. Establish and maintain good work relationships.
COMMUNICATION: Clearly convey information and ideas through a variety of media to individuals or
groups in a manner that engages the audience and helps them understand and retain the message.
CONTRIBUTING TO TEAM SUCCESS: Actively participate as a member of the team to move toward the completion of goals.
CUSTOMER FOCUS: Make customers, and their needs, a primary focus of one's actions. Develop and sustain productive customer relationships.
INITIATING ACTION: Take prompt action to accomplish objectives. Take action to achieve goals beyond what is required, be proactive. Anticipate consequences of decisions and actions.
Communicate recommendations to take preventative steps and initiate further action
MANAGING WORK manages time and resources to ensure that work is completed efficiently.
QUALITY ORIENTATION: Accomplish tasks by considering all areas involved, no matter how small. Show concern for all aspects of the job. Accurately check processes and tasks. Be watchful over time, meet demanding deadlines, learn quickly and exhibit organization in work habits.
STRESS TOLERANCE: Maintain stable performance under pressure or opposition, such as, time pressure or job ambiguity. Handle stress in a way that is acceptable to others and to the organization.
TECHNICAL/PROFESSIONAL KNOWLEDGE AND SKILLS achieve a satisfactory level of technical and professional skills, or knowledge in position related areas. Keep up with current developments and trends in area of expertise. Display a strong work ethic demonstrated in attendance, punctuality, maturity and dedication. Maintain a positive attitude.
EDUCATION:
BS / BA or Equivalent Work Experience
Experience:
3
years of professional work experience
Previous work in medical claims or medical billing
Enter job descriptionEstimated Salary: $20 to $28 per hour based on qualifications.
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