Job Details

Medical Bill Coordinator - Remote
PRIMARY PURPOSE
To review hospital and professional medical bills from provider including complex hospital, surgical, high level evaluation and management codes, and/or technical bills.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Processes bills in accordance with multi state schedules, rules, regulations, and guidelines.

Applies PPO contract discounts to bills.

Reviews operative reports to determine if surgery services were appropriately billed.

Reviews complex medical, legal and consult services.

Contacts client or facility to obtain additional or missing information.

Handles provider appeals where appropriate to fee schedule and contractual disputes.

Communicates internal issues to management.

Assists bill review team lead with workflow management, coaching and mentoring of staff.

Assists with process, procedure and system training for new staff.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization's quality program(s).

Travel as required.

QUALIFICATIONS
Education & Licensing
High School diploma or GED required.

Experience
Two (2) years workers compensation and/or bill review experience or equivalent combination of education and experience required to include provider appeals experience. PPO re-pricing, surgery review by report and RNE review preferred. Two (2) years of experience with complex medical, legal and consult review preferred.

Skills & Knowledge

Knowledge of re-pricing rules and guidelines

Knowledge of medical terminology, anatomy and surgical terms

Knowledge of multiple state jurisdictional regulations and rules

Knowledge of Fee Schedules, Rules, and U&C Guidelines

Knowledge of CPT/ICD9

PC literate, including Microsoft Office products

Leadership skills and ability to motivate others

Strong verbal and written communication skills

Strong interpersonal skills

High level of accuracy and attention to detail

Ability to multi-task and function in high volume area

Ability to handle deadlines and proactively problem solveAbility 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

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

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