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Bill Review Specialist – Workers Compensation
EK Health Services Inc.. Accurately analyze complex medical bills and make payment recommendations based on claim history, medical notes, usual and customary rates, statutory regulations including state laws and fee schedules, available MPN/PPO contracts, coding guidelines, client instructions, and company policies and procedures .
Core Competencies
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Demonstrates expertise in analyzing complex medical bills and applying knowledge of medical terminology, CPT codes, and DRG to ensure accurate billing practices. Strong communication and organizational skills are essential for effective client interaction and quality assurance processes.
ATS Keywords
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About the role
Key responsibilities & impact- Accurately analyze complex medical bills and make payment recommendations based on claim history, medical notes, usual and customary rates, statutory regulations including state laws and fee schedules, available MPN/PPO contracts, coding guidelines, client instructions, and company policies and procedures
- Review and verify correct use of medical billing codes and report improper use of billing codes to the Bill Review Manager
- Participate in the quality assurance process from initial receipt of bills through final payment
- Monitor and correct duplications and inaccurate or outdated data to protect system integrity
- Communicate with medical providers to obtain needed information and resolve bill-specific issues
- Communicate directly with clients and respond to their questions quickly and professionally
- Participate in ongoing training to enhance job skills and knowledge
- Perform other duties as assigned
- Report to the Bill Review Supervisor
- Work remotely Monday through Friday, 7am–4pm local time
Requirements
What you’ll need- High School Diploma required; some college or college degree preferred
- 2+ years of experience in complex Workers' Compensation Bill Review with customer service exposure
- Knowledge of medical terminology, CPT codes, and DRG
- Ability to read, analyze, and interpret technical procedures, medical reports, state laws and fee schedules
- Hospital Bill Review experience a plus
- CPC (Certified Professional Coding) coursework or certification a big plus
- Excellent Written and Oral Communication & Interpersonal Skills
- Strong Organization Skills
- High comfort level with computers and computer programs (MS Word, MS Excel, Email)
- Ability to meet deadlines in a high pressure, time sensitive environment
- Ability to lift up to 20 lbs.
- Candidate must be able to sit the majority of an 8-hour day except for lunch and break times
- Candidate must be able to keyboard the majority of an 8-hour day except for lunch and break times
- Candidate must have manual dexterity
- Candidate must be able to speak on the telephone intermittently throughout the day
- Candidate must be able to read and write English fluently
- Candidate must be able to provide and confirm safe home office environment
- Home office must be HIPAA compliant
- Requires DSL, fiber, or cable internet connection from home; 100 Mbps preferred or better
- Applicants residing in California, New York, or Hawaii are not being accepted or considered
Benefits
Comp & perks- Medical, Dental and Vision Insurance
- 401K
- Paid Time Off
- Paid Holidays
- Monthly internet stipend
- Equipment provided