Job Description
Purpose:
Join our team and play a vital role in ensuring timely and accurate application of PPO guidelines to medical bills. This position involves managing manual processes and collaborating with various stakeholders to facilitate smooth and efficient bill processing.
Essential Job Functions:
Provider Identification: Determine whether providers are participating or non-participating when automated systems are unable to do so.
Guideline Application: Apply PPO guidelines accurately to bills where a match has been identified, especially when the automated re-pricing system is unable to apply these guidelines.
Client and Internal Communication: Engage with clients and internal Bill Review staff via email or phone to:
Request bill images or documentation necessary for applying PPO discounts.
Address keying errors or discrepancies and request corrections to ensure accurate discount application.
Team Collaboration: Communicate with the PPO Application team through various channels regarding specific bill questions or general policies and procedures.
Rate Calculation: Use appropriate software and documents to calculate contracted rates, which may include calculations based on AWP, Medicare, or state and federal-mandated fee schedules.
Quality Assurance Assistance: Support the Senior PPO Application Specialist with the QA process when needed.
Education:
High School Diploma required.
Required Experience and Skills:
Medical Bill Processing: Familiarity with medical bill processes, including knowledge of CPT Codes, Revenue Codes, Bill Types, ICD-9 and/or ICD-10 Codes, State Fee Schedules, UCR, and PPO.
Technical Proficiency: Experience working with Windows-based software and applications.
Attention to Detail: Ability to type accurately and review documentation to make informed decisions based on department policies and procedures.
Team Player: A strong desire to work well with others.
Self-Motivation: A proactive attitude and the drive to be a self-starter.
Equal Employment Opportunity Statement:
We are committed to providing equal employment opportunities to all employees and applicants. We prohibit discrimination and harassment of any kind based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, 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, Local area,