Bill Reviewer III

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

📋 Description

• Accurately input medical bills into the company's system while adhering to production standards.

• Conduct preliminary evaluations to assess the appropriateness and medical necessity of provided services.

• Utilize CPT and ICD9/ICD10 codes, along with fee schedules and resource materials, to establish suitable reimbursement levels.

• Implement relevant fee schedules and repricing rationale.

• Identify and flag problematic bills for the Bill Review supervisor's attention.

• Engage in communication with clients and/or providers to clarify any required information.

• Refer unidentifiable unlisted procedure numbers to the Bill Review supervisor.

• Price hospital and surgical bills in accordance with applicable fee schedules.

• Process assigned reconsideration requests.

• Specialize in state-specific or client-specific areas as necessary.

• Assist in responding to provider inquiries.

• Achieve daily production targets and maintain quality standards.

• Operate with minimal supervision; no supervisory duties are required.

⛳️ Requirements

• High school diploma or general education degree (GED) is required.

• At least one year of experience in data entry/medical billing is necessary.

• Additional two years of bill review experience in a workers’ compensation setting is preferred.

• Strong oral and written communication skills are essential.

• In-depth knowledge of CPT and ICD9/ICD10 coding, along with workers’ compensation fee schedules, is required.

• Familiarity with workers’ compensation regulations is important.

• Good understanding of the company's software system process is needed.

• Ability to perform basic mathematical calculations, including rates, ratios, and percentages.

• Proficiency in using word processing, spreadsheet, and database software is necessary.

• Must possess Medical Bill Reviewer Designation – including a 40-hour initial certification and 16 hours of continuing education every two years.

• Capability to work an eight-hour shift, remain seated for extended periods, type or operate a keyboard most of the day, and read a video display terminal for long durations.

🏝️ Benefits

• Comprehensive medical, dental, and vision benefits.

• Company contributions to HSA and FSA plans.

• Employer-paid life and disability insurance.

• 401(k) plan with company matching.

• Paid time off (PTO) and company-paid holidays.

• Opportunities for learning and development that facilitate genuine career advancement.

• Employee assistance resources and a supportive culture that values balance and well-being.