Under limited supervision, processes and audits medical bills in accordance with workers' compensation fee schedules.
The role is responsible for reviewing billed services, applying CPT and ICD-9/ICD-10 codes, identifying appropriate reimbursement amounts, and communicating with clients, providers, and internal supervisors as needed.
Key duties include:
- Coding medical bills into the company system with speed and accuracy
- Screening for appropriateness and medical necessity of services rendered
- Using fee schedules and repricing references to determine reimbursement
- Flagging problem bills for supervisory review
- Clarifying information with clients and providers
- Pricing hospital and surgery bills to applicable fee schedules
- Processing reconsideration requests
- Supporting state-specific or client-specific bill review work
- Assisting with provider calls when needed
Requirements & Qualifications
Education and experience:
- High school diploma or GED
- Minimum 1 year of data entry or medical billing experience
- Additional 2 years of bill review experience in a workers' compensation environment
- Excellent oral and written communication skills
Knowledge and skills:
- Strong knowledge of CPT and ICD-9/ICD-10 coding
- Familiarity with workers' compensation fee schedules and regulations
- Good understanding of company software systems
- Ability to perform basic math calculations
- Ability to apply common sense and solve problems in standardized situations
- Computer skills with word processing, spreadsheet, and database software
Certification:
- Medical Bill Reviewer Designation required
- 40-hour initial certification plus 16 continuing education hours every 2 years
Benefits & Perks
AvonRisk offers a competitive benefits package, including:
- Medical, dental, and vision coverage
- Company contributions to HSA and FSA plans
- Employer-paid life and disability insurance
- 401(k) with company match
- Paid time off and company-paid holidays
- Learning and development opportunities
- Employee assistance resources
- Supportive, balance-focused culture
Location
California, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
4 months ago
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