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.
