Job Description

Position Overview:

We are looking for a detail-oriented professional to join our team, responsible for managing manual processes that ensure accurate and timely application of PPO guidelines to medical bills. Your expertise will be key in ensuring that these processes run smoothly and efficiently, contributing to the overall success of our billing operations.

Key Responsibilities:

Provider Identification: When automated systems are unable to determine provider participation, you will manually identify whether a provider is participating or non-participating.
PPO Guideline Application: Accurately apply PPO guidelines to medical bills when the automated re-pricing process is unable to do so.
Client and Internal Communication: Work closely with clients and our Bill Review team via email or phone to request necessary bill images or documentation and to address keying errors or discrepancies.
Collaboration with PPO Team: Engage with the PPO Application team to discuss any questions or concerns about specific bills, policies, or procedures, ensuring clarity and accuracy in our processes.
Rate Calculation: Utilize appropriate software and documents to calculate contracted rates, including calculations based on AWP, Medicare, or applicable state or federal fee schedules.
Quality Assurance Support: Assist the Senior PPO Application Specialist with quality assurance processes when needed.
Qualifications:

Education: A high school diploma is required.
Experience: Previous experience with medical billing processes, including knowledge of CPT codes, Revenue codes, Bill types, ICD-9 and/or ICD-10 codes, State Fee Schedules, UCR, and PPO.
Technical Skills: Proficiency in Windows-based software/applications and the ability to type accurately.
Analytical Skills: Strong ability to review documentation and make informed decisions based on established department policies and procedures.
Teamwork: A collaborative spirit and a desire to work well with others.
Self-Motivation: An ability to take initiative and work independently.
Our Commitment to Equality:

We are an equal opportunity employer committed to fostering an inclusive environment for all employees. We prohibit discrimination of any kind based on race, color, religion, age, sex, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other protected characteristic. This policy applies to all aspects of employment, including hiring, placement, promotion, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour

Job Tags

Hourly pay, Full time, Contract work,

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