Medical Bill Reviewer Plano, TX

Job Description

Job Description

The Reny Company's bill reviewer is a professional who combines experience in health insurance and medical billing with business insight and a passion for great service. Purpose of this role is to support Claims by analyzing medical, hospital, durable medical equipment, pharmacy, home health, etc. bills and records/reports to determine billing accuracy and appropriateness. This support is achieved by utilizing intelligent software and by understanding and applying knowledge of medical code billing and claims processing rules and regulations, billing practices, code sets, and state and Medicare adjustment reimbursement principles, knowledge of WC fee schedules.

Support is also achieved by providing education and training regarding provider billing and documentation, identifying and bringing to management's attention any unusual or emerging procedures or billing anomalies. The bill reviewer will ensure the highest level of accuracy of data entry into our bill review system for claims processing.

PLEASE DO NOT APPLY IF YOU DON'T HAVE THE EDUCATION AND MEDICAL BILL REVIEW EXPERIENCE

Experience Requirements:

Two or more years of experience in a medical bill review analyst position preferred. Medical coding knowledge needed. Prior experience in a payer environment working with claims systems and bill review software is a plus.

Production Requirements:

• Based upon situation or state specific issues meet 98% accuracy, 10,000+ keystrokes per hour

Responsibilities:

• Process medical bills for workers' compensation, Texas non subscription, maritime, occupational accident, and liability claims
• Data entry into system applying usual and customary, worker's compensation and liability ground rules and fee schedules
• Continuous enhancement of working knowledge of medical forms such as CMS-1500, UB-92, UBO4/DWC-9/DWC-10
• Increase knowledge of coding principles CPT, ICD-9 / ICD-10, DRG, Revenue codes
• Responsible for processing a minimum quota per day with an error rate of 98% or better
• Increase knowledge on pre-authorization guidelines in order to pay/deny bills accordingly
• Ensure all bill processing is specific to client requests
• May be asked to perform other duties as management deems necessary

Education/

Qualifications:

Associates degree or equivalent work experience Certified Professional Coder certification such as CCA. CCS, CCS-P, CPC, CPC-P from a generally recognized professional organization such as AHIMA or AAPC

• Experience with Medical Bill Review preferred
• High school diploma or equivalent, college preferred
• Two to three years of medical claims experience
• Trained in ICD
  10 preferred
• Workers’ Compensation experience preferred
• Fee Schedule knowledge and Medicare experience preferred
• Knowledgeable of Excel, Word, Outlook, etc.
• Ability to multi-task effectively while meeting or exceeding aggressive deadlines
• Ability to work independently and in a team environment

The Reny Company is an Equal Opportunity Employer. In order to provide equal employment and advancement opportunities to all individuals, employment decisions at The Reny Company will be based on merit, qualifications and abilities. Except where required or permitted by law, employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex, national origin, ancestry, citizenship, age, handicap or disability, marital status, medical condition or any other characteristic protected by applicable law.

THIS IS NOT A REMOTE POSITION

ONLY THOSE WITH RELEVANT EDUCATION AND MEDICAL BILL REVIEW EXPERIENCE NEED APPLY

The Reny Company is a rapidly growing health care cost containment company, helping clients save money and better navigate our changing health care system. We specialize in medical bill review and negotiation services for workers compensation, non-subscribers, third party administrators, and maritime clients.