Bill Review Specialist – Workers Compensation

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Carefully and accurately evaluate intricate medical bills, providing payment recommendations informed by claim history, medical documentation, customary rates (UCR), applicable statutory regulations including state laws and fee schedules, available MPN/PPO agreements, coding standards, client directives, and company policies and procedures.

• Examine and confirm the appropriate application of medical billing codes, reporting any improper usage to the Bill Review Manager.

• Engage in the quality assurance (QA) process from the initial receipt of bills through to the final payment.

• Safeguard system integrity by monitoring and rectifying duplications and incorrect or outdated data.

• Collaborate with healthcare providers to gather necessary information and address bill-specific concerns.

• Directly communicate with clients, promptly and professionally addressing their inquiries.

• Take part in ongoing training to improve job-related skills and knowledge.

• Undertake additional responsibilities as assigned.

• Report to the Bill Review Supervisor.

• Work remotely from Monday to Friday, 7am–4pm local time.

⛳️ Requirements

• High School Diploma is mandatory; some college education or a degree is preferred.

• A minimum of 2 years’ experience in complex Workers' Compensation Bill Review with exposure to customer service.

• Familiarity with medical terminology, CPT codes, and DRG.

• Capability to read, analyze, and interpret technical procedures, medical reports, state regulations, and fee schedules.

• Experience in Hospital Bill Review is an advantage.

• CPC (Certified Professional Coding) coursework or certification is a significant plus.

• Exceptional written and verbal communication and interpersonal skills.

• Strong organizational abilities.

• High comfort level with computers and software programs (MS Word, MS Excel, Email).

• Ability to adhere to deadlines in a high-pressure, time-sensitive environment.

• Capacity to lift up to 20 lbs.

• Candidate must be able to sit for the majority of an 8-hour workday, aside from lunch and breaks.

• Candidate must be able to type for the majority of an 8-hour workday, aside from lunch and breaks.

• Candidate must possess manual dexterity.

• Candidate must be able to speak on the phone intermittently throughout the day.

• Candidate must be fluent in reading and writing English.

• Candidate must ensure a safe home office environment.

• Home office must comply with HIPAA regulations.

• A DSL, fiber, or cable internet connection from home is required; 100 Mbps or better is preferred.

🏝️ Benefits

• Medical, Dental, and Vision Insurance.

• 401K plan.

• Paid Time Off.

• Paid Holidays.

• Monthly internet stipend.

• Equipment provided.