Medical Bill Adjuster

• Process medical invoices based on a pre-determined quota.
• Ensure bills are related to compensable injury.
• Research medical records to determine appropriate coding.
• Audit and process inpatient hospital bills.
• Audit and process higher-dollar claims.
• Audit high-level evaluation and management bills for appropriate billing.
• Review invoices for correct coding and correct usage of modifiers.
• Approve additional units for payment for certain CPT/HCPCS codes.
• Discuss billing matters with medical providers, claims adjuster, and customers.
• Identify vendor trends and training needs and make recommendations accordingly.
• Prepare reports and compile comprehensive data relating to the vendor review unit.
• Analyze and manipulate report data.
• Consult as needed with other staff regarding training needs.
• Perform system testing as needed.
• Perform other duties as assigned.

• Associate or bachelor’s degree from an accredited college or university is strongly preferred; commensurate experience may be considered.
• A minimum of three years of experience in medical coding or medical bill processing is required.
• Certification in medical coding from either AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association) is strongly preferred.
• Strong attention to detail.
• Extensive knowledge of medical billing, ICD-10, CPT-4, DRG and HCPCS coding.
• Comprehensive understanding of medical invoices and forms.
• Effective computer skills.
• Ability to effectively prioritize and carry out work assignments.
• Strong computer skills.
• Strong communication skills.
• Ability to use and apply basic math skills.
• Understanding of Preferred Provider Organization (PPO).
• Extensive knowledge of medical terminology.
• Excellent data entry skills.
• Residence and work within one of Encova Insurance’s eligible U.S. states.

Demonstrates extensive knowledge of medical billing processes, including ICD-10, CPT-4, DRG, and HCPCS coding, while effectively managing medical invoices and ensuring compliance with billing standards. Strong attention to detail and communication skills are essential for collaborating with medical providers and analyzing billing data.

• Medical Coding Certification
• ICD-10 Coding
• CPT-4 Coding
• Medical Billing Experience
• Data Analysis

• Medical Billing
• ICD-10
• CPT-4
• DRG Coding
• HCPCS Coding
• Data Entry
• Report Compilation
• System Testing
• Medical Terminology
• Basic Math Skills

• Attention to Detail
• Communication Skills
• Prioritization

• AAPC Certification
• AHIMA Certification

• Medical Invoices
• Compensable Injury
• Preferred Provider Organization
• Vendor Review

• Billing Software
• Medical Records Systems