Bill Review Specialist – Workers Compensation

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

📋 Description

• Thoroughly evaluate intricate medical bills and propose payment recommendations informed by claim history, medical documentation, customary rates, regulatory statutes including state laws and fee schedules, available MPN/PPO contracts, coding guidelines, client directives, and company policies and procedures.

• Assess and confirm the accurate application of medical billing codes while reporting any improper usage of these codes to the Bill Review Manager.

• Engage in the quality assurance process from the initial reception of bills to final payment.

• Oversee and rectify duplications and any inaccurate or outdated data to ensure system integrity.

• Liaise with medical providers to gather necessary information and resolve bill-specific concerns.

• Directly communicate with clients, providing prompt and professional responses to their inquiries.

• Partake in ongoing training to enhance job-related skills and knowledge.

• Carry out 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 required; some college education or a college degree is preferred.

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

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

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

• Experience in Hospital Bill Review is advantageous.

• Completion of CPC (Certified Professional Coding) coursework or certification is a significant asset.

• Exceptional written and verbal communication and interpersonal skills.

• Strong organizational abilities.

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

• Ability to meet deadlines in a fast-paced, time-sensitive environment.

• Capability to lift up to 20 lbs.

• Candidates must be able to sit for the majority of an 8-hour day, excluding lunch and breaks.

• Candidates must be able to type for the majority of an 8-hour day, excluding lunch and breaks.

• Candidates must possess manual dexterity.

• Candidates must be able to communicate over the telephone intermittently throughout the day.

• Candidates must be able to read and write in English fluently.

• Candidates must ensure a safe home office environment.

• The home office must comply with HIPAA regulations.

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

• Applicants residing in California, New York, or Hawaii will not be accepted or considered.

🏝️ Benefits

• Medical, Dental, and Vision Insurance.

• 401K.

• Paid Time Off.

• Paid Holidays.

• Monthly internet stipend.

• Equipment provided.