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Medical Bill Reviewer-100% remote (Anywhere in US) ID-8366

 MEDICAL BILL REVIEWER-100% REMOTE ( Anywhere in US )

 

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

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PURPOSE: Responsible for handling manual processes involved in applying PPO guidelines to medical bills in a timely and accurate manner.

ESSENTIAL JOB FUNCTIONS

  • Identify a provider as participating or non-participating when the automated matching process is not able to make that determination.
  • Accurately apply PPO guidelines to those bills where a participation match has been made when the automated re-pricing process is not able to apply the guidelines.
  • Communicate with clients and internal Bill Review staff via e-mail or phone:
    1. To request bill images or documentation when necessary to properly apply a PPO discount.
    2. To question keying errors or discrepancies and request corrections to properly apply a PPO discount.
  • Communicate with the PPO Application team via e-mail, phone, or in person regarding questions and concerns about specific bills or general policies and procedures.
  • Utilize appropriate software and documents to calculate contracted rates, which may include, but is not limited to the calculation of AWP, Medicare, or applicable state or federal-mandated fee schedule.
  • Assist the Senior PPO Application Specialist with the QA process when necessary.

EDUCATION: High School Diploma Required

 

REQUIRED EXPERIENCE AND SKILLS:

  • Experience with medical bill processes, including familiarity with CPT Codes, Revenue Codes, Bill Types, ICD-9 and/or ICD-10 Codes, State Fee Schedules, UCR, and PPO.
  • Experience working with Windows-based software /applications.
  • Ability to type with accuracy.
  • Ability to review documentation and make decisions on how to proceed based on department policies and procedures.
  • Desire to work well with others.
  • Motivation to be a self-starter.

 

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