Pittsburgh, Pennsylvania
Medical Bill Reviewer Job Opening in Pittsburgh, Pennsylvania - Performs medical bill review according to various Workers? Compensation Guidelines in various states, primarily Pennsylvania. This includes understanding National Correct Coding Initiatives, Global and Multiple Surgical Guidelines, and Trauma Guidelines
Use of proper reason codes to deny improper billing and adjust payments to providers
Reviews repriced bills for accuracy before sending them back to clients
Ensures billing turnaround time for insurance companies and clients
Communicates with adjusters and/or healthcare providers to obtain missing information that is needed to reprice bills
Responds to inquiries from adjusters and/or healthcare providers regarding the analysis on the Explanation of Reimbursements (EOR?s), including the explanation of the Reason Codes
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Ensures that personnel, client, donor and volunteer files are securely stored and is maintained.
Performs various other reasonable duties as directed by management
Qualifications
High School Diploma or equivalent
Business school graduate preferred or equivalent work experience
Medical Coding Certificate or equivalent work experience
Typing 45 ? 50 wpm, including 10-key experience
Communication and Customer Service skills
Proficient in Microsoft Office including Word, Excel, and Outlook
Experience working with Explanation of Reimbursements (EOR?s)
Experience reviewing all types of medical bills and records
Experience working with medical billing forms (UB-04 and HCFA-1500)
Other Valued Experience
Experience testifying at a fee review hearing
Experience providing testimony for a deposition
Experience with Trauma Discount Negotiations
Job Type: Full-time
Required education:
High school or equivalent
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