Strategic Bill Review Analyst - Workers' Compensation
New
R
Rising Medical SolutionsHealthcare Insurance
Milwaukee, Wisconsin, United StatesFull-TimeMiddle
SalaryCompetitive base salary
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Job Details
- Experience
- Minimum one to three years
- Required Skills
- Microsoft Excel
Requirements
- High School Diploma required; Associate or Bachelor Degree preferred.
- Minimum one to three years of medical bill review, auditing, and/or medical bill negotiation experience.
- Ability to read, analyze, and interpret technical procedures, medical reports, state laws, fee schedules, and CPT codes.
- Ability to effectively present information and respond to questions from peers, clients, and providers.
- CPC (Certified Professional Coding) coursework or certification is a plus.
- Must obtain CPC certification within two years of assuming the position.
- Proficiency with software programs including Vision, Smart Advisor, and Excel.
Responsibilities
- Review and organize litigation responses, ensuring bill review accuracy and defending repricing strategies.
- Appear as an expert witness for litigated cases, hearings, depositions, and fee coder affidavits as needed.
- Drive innovation in bill review repricing strategies, workflow creation, and documentation.
- Develop specialty bill review repricing strategies and products such as network reductions and guarantee programs.
- Analyze specialty and large medical bills to make payment recommendations using claim history, CPT codes, state laws, and fee schedules.
- Utilize software including Vision, Smart Advisor, and Excel to maximize productivity.
- Communicate with medical providers and clients to resolve issues and provide professional service.
- Mentor and train less-experienced auditors.
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