The Role
Reviews and audits medical bills, payment determinations, reconsiderations, and re-reviews. Interprets medical documentation, test results, treatment plans, procedure codes, and reimbursement policies to determine accurate payment. Adjusts technical bills, maintains reimbursement references, and conducts compliance test studies under deadlines. Works independently within established procedures and supports quality service while working overnight, weekend, holiday, and overtime shifts as needed.
Summary Generated by Built In
Job Track Description:
- Performs tasks based on established procedures.
- Uses data organizing and coordination skills to perform business support or technical work.
- Requires vocational training, certifications, licensures, or equivalent experience.
General Profile
- Expands skills within an analytical or operational process.
- Maintains appropriate licenses, training, and certifications.
- Applies experience and skills to complete assigned work.
- Works within established procedures and practices.
- Works with a moderate degree of supervision.
Functional Knowledge
- Has developed skillset in a range of processes, procedures, and systems.
Business Expertise
- Understanding of how teams integrate and work best together to support the achievement of company goals.
Impact
- Impacts a team, by example, through the quality service and information provided
- Follows standardized procedures and receives moderate supervision and guidance.
Leadership
- Has no supervisory responsibilities.
- Manages own workload.
Problem Solving
- Uses existing procedures to solve standard problems without supervisory approval.
Interpersonal Skills
- Exchanges information and ideas effectively.
Responsibility Statements
- Audits payment determination, reconsiderations, and re-reviews on Medical Bill Data.
- Assists in assigning procedure codes regarding complex issues and comprehensive exam codes.
- Examines and adjusts lower-level technical bills, including high-level office visits, reports, and record reviews.
- Analyzes medical reports, test results, and treatment plan to determine proper payment or reimbursement.
- Maintains reference library of company and industry reimbursement policies
- Conducts test studies for the compliance team, requiring high-quality results and strict deadlines.
- Performs other duties as assigned.
- Complies with all policies and standards.
Qualifications
- Experience in medical bill review, claims processing, or a related field preferred.
- Strong analytical and attention-to-detail skills.
- Proficiency in Microsoft Office applications and relevant bill review systems.
- Ability to interpret medical documentation and reimbursement policies.
This position requires working on a Graveyard (GY) Shift schedule.
Willingness to work overnight hours, weekends, holidays, and overtime as business needs require.
Skills Required
- Experience in medical bill review, claims processing, or a related field
- Strong analytical skills and attention to detail
- Proficiency in Microsoft Office applications and relevant bill review systems
- Ability to interpret medical documentation and reimbursement policies
- Willingness to work overnight hours, weekends, holidays, and overtime as business needs require
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The Company
What We Do
Founded in 1994 and headquartered in Conshohocken, Pennsylvania, MedRisk was established with a mission to revolutionize physical rehabilitation for workers' compensation patients. Over the last 30 years, the company has evolved into a leading managed care organization dedicated to physical rehabilitation and medical bill review for the casualty claims industry.
