Bill Review Associate III at MedRisk LLC

Mandaluyong, Metro Manila, Philippines -

Full Time

Start Date

Immediate

Expiry Date

09 Apr, 26

Salary

0.0

Posted On

09 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Analytical Skills, Operational Processes, Data Organization, Communication, Problem Solving, Medical Billing, Compliance, Interpersonal Skills, Fee Schedule Reduction, PPO Reduction, Usual and Customary Reduction, Medicare Reduction, Hospital Review Guidelines, Record Reviews, High-Level Office Visits, Test Studies

Industry

Hospitals and Health Care

Description

Bill Review Services Associate III.docx [blob:https://workforcenow.adp.com/c4f1fe88-3230-41b2-8a33-feb5d43eefe5] 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: * Proficiency within a range of analytical or operational processes * Completes atypical assignments * Works within established procedures and practices * May establish the appropriate approach for new assignments * Acts as a resource for colleagues * Completes work with limited 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 * Uses discretion to change work procedures and practices Leadership: * May provide guidance and support to junior team members * Problem Solving : Provides solutions to atypical problems based on existing precedents or procedures Interpersonal Skills: * Exchanges information and ideas effectively Responsibility Statements: * Reviews specialized Medical Bills including hospital, surgery, and high-level physician bills * Establishes the appropriateness of a final reimbursement outcome by making the distinction between and knowing when to apply either Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction * Communicates and upholds the basis for the methodology used to accomplish the reduction of charges * Analyzes and reviews high-level office visits, reports, and record reviews * Interprets hospital review guidelines for both inpatient and outpatient claims * 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

Responsibilities

The Bill Review Associate III reviews specialized medical bills and establishes appropriate reimbursement outcomes. They analyze high-level office visits and interpret hospital review guidelines for claims.