Bill Review Specialist

As a Bill Review Specialist, you will apply WellRithms’ reimbursement methodology through medical bill review. This role focuses on accurately processing medical bills, reviewing CPT coding, and evaluating reimbursement requests in a high-volume environment. You will work with client workflows, reimbursement guidelines, regulatory requirements, and provider billing practices to help ensure consistent and accurate bill review outcomes. The position reports to the Bill Review Supervisor.

Responsibilities

• Analyze medical bills and apply the WellRithms reimbursement methodology accurately and consistently.
• Review medical bills, medical records, itemized statements, and supporting documentation to determine reasonable reimbursement.
• Review, process, and validate CPT codes and other applicable medical billing standards.
• Investigate billing discrepancies, reimbursement disputes, and reconsideration requests.
• Identify and correct billing, coding, and documentation errors within established workflows.
• Communicate with medical providers and other stakeholders to obtain additional information and facilitate claim resolution.
• Stay current on industry trends, reimbursement guidelines, fee schedules, and regulatory changes.
• Meet productivity and quality assurance expectations while managing a high-volume workload.