Job Description
Purpose:
As a key member of our team, you will be responsible for managing the manual processes involved in accurately applying PPO guidelines to medical bills. Your work ensures that these processes are completed promptly and with precision, helping us maintain the highest standards of service.
Essential Job Functions:
Provider Identification: When automated systems cannot determine a provider's participation status, you will step in to identify whether they are participating or non-participating.
Guideline Application: Apply PPO guidelines to bills where participation matches have been made, particularly in cases where automated re-pricing systems are unable to do so.
Communication:
Work closely with clients and our internal Bill Review team via email or phone to request necessary bill images or documentation to accurately apply PPO discounts.
Address keying errors or discrepancies, and request necessary corrections to ensure accurate application of PPO discounts.
Collaboration: Partner with the PPO Application team via email, phone, or in person to address specific questions and concerns related to individual bills or broader policies and procedures.
Rate Calculation: Utilize appropriate software and documents to calculate contracted rates, including but not limited to AWP, Medicare, and applicable state or federal fee schedules.
Quality Assurance: Support the Senior PPO Application Specialist with the QA process as needed to maintain accuracy and consistency.
Education:
High School Diploma or equivalent is required.
Required Experience and Skills:
Strong familiarity with medical bill processing, including CPT Codes, Revenue Codes, Bill Types, ICD-9 and/or ICD-10 Codes, State Fee Schedules, UCR, and PPO guidelines.
Proficiency with Windows-based software and applications.
Accurate typing skills and keen attention to detail.
Ability to review documentation, assess situations, and make informed decisions based on department policies and procedures.
Team-oriented with a strong desire to collaborate effectively with others.
Self-motivated with the initiative to start and complete tasks independently.
Equal Employment Opportunity Statement:
We are committed to providing equal employment opportunities to all employees and applicants. We do not tolerate discrimination or harassment of any kind, regardless of race, color, religion, age, sex, national origin, disability status, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by law. This policy applies to all aspects of employment, including recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour
Job Tags
Hourly pay, Full time,