Bill Reviewer III

Description

Avon Risk is the nation’s leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers’ compensation, liability, managed care, and risk management across 32 states. With nearly 700 professionals and brands including Intercare, Inter Med, George Hills, and AS&G Claims Administration, we’re a people-focused, operations-driven organization that prioritizes reasonable caseloads, strong training, collaborative teams, and expert support. We invest in tools and workflows that reduce friction—not increase volume—and create real career paths for professionals who want to grow their careers or move into leadership.

At Avon Risk, you’re part of a team that values good judgment, curiosity, and accountability, and gives you the support to succeed.

Summary:

Under limited supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers’ compensation fee schedule by performing the following duties.

Essential Duties and Responsibilities:

• Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output.
• Performs preliminary screening for appropriateness and medical necessity of services rendered.
• Uses CPT and ICD9/ICD
  10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational.
• Flags any problem bills to the   supervisor.
• Communicates with clients and/or providers to clarify information.
• Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers.
• Ability to price hospital and surgery bills to applicable fee schedules.
• Ability to process reconsideration requests as assigned.
• May specialize in state specific or client specific areas of responsibility.
• May assist is answering provider calls.

Competency:

To perform the job successfully, an individual should demonstrate the following competencies:

• Design
  - Demonstrates attention to detail.
• Oral Communication
  - Speaks clearly and persuasively in positive or negative situations;
  Listens and gets clarification;
  Responds well to questions.
• Team Work
  - Supports everyone's efforts to succeed.
• Quality
  - Demonstrates accuracy and thoroughness;
  Looks for ways to improve and promote quality;
  Applies feedback to improve performance;
  Monitors own work to ensure quality.
• Quantity
  - Meets productivity standards;
  Completes work in timely manner;
  Strives to increase productivity;
  Works quickly.

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or

Experience:

High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers’ comp environment.

Language

Skills:

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Knowledge

Skills:

Strong knowledge of CPT and ICD9/ICD
10 coding and workers compensation fee schedules. Must be familiar with workers’ compensation regulations and have good comprehension of company software system process.

Math

Skills:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common…