Medical Bill Review Quality Auditor

Join our growing team of dedicated professionals at Gallagher Bassett, who guide those in need to the best possible outcomes for their health and wellbeing. You'll be part of a resilient team that works together to redefine the boundaries of excellence. At our organization, we value collaboration and making a positive impact in the lives of our clients and claimants, offering you the opportunity to join a team where your skills and dedication can truly make a difference.

GUIDE. GUARD. GO BEYOND.

We believe that every candidate brings something special to the table, including you! So, even if you feel that you’re close but not an exact match, we encourage you to apply.

We are seeking a detail-oriented and experienced Medical Bill Review Quality Auditor to join our team. This role is critical in ensuring the accuracy, compliance, and quality of our medical bill review processes. The ideal candidate will have a strong background in Managed Care, extensive knowledge of medical bill review, and experience as a medical bill review coder. This individual will play a key role in maintaining high-quality standards, identifying process improvements, and delivering exceptional service to our clients.

Proactive Audits:

• Conduct regular audits of processed medical bills to ensure fee set-ups, exception processes, and other configurations are functioning as intended.
• Identify discrepancies, errors, or inefficiencies and recommend corrective actions.

Client-Specific Audits:

• Perform detailed audits tailored to specific client requirements to ensure compliance with contractual obligations and client expectations.
• Collaborate with account teams to address client-specific concerns and provide actionable insights.

Vendor Invoice Auditing:

• Review and audit vendor invoices to ensure accuracy, compliance with agreements, and proper billing practices.
• Identify and resolve discrepancies in vendor billing.

Reporting and Scorecards:

• Develop and deliver client-specific reports and scorecards, providing clear insights into performance metrics, audit findings, and recommendations.
• Ensure timely and accurate reporting to meet client and internal deadlines.

Quality Assurance:

• Monitor and evaluate the overall quality of the medical bill review process, identifying areas for improvement.
• Collaborate with internal teams to implement process enhancements and maintain high-quality standards.

Additional Responsibilities:

• Support various tasks associated with ensuring the medical bill review option operates efficiently and effectively.
• Stay updated on industry trends, regulatory changes, and best practices in medical bill review and Managed Care.

Required:

• Typically requires a University Degree or equivalent experience and minimum 7 years of prior relevant experience.
• Extensive experience with Workers’ Compensation bill review and network access processes.
• Prior vendor management and project management experience.
• Strong oral and written communication skills.
• Ability to support transformational planning and the development of business cases.

Preferred:

• Minimum of 3-5 years of experience in Managed Care, with a strong focus on medical bill review and auditing.
• In-depth knowledge of medical bill review processes, coding standards (e.g., CPT, ICD-10, HCPCS), and fee schedules.
• Certified Professional Coder (CPC) or equivalent certification preferred.
• Strong attention to detail with the ability to identify patterns, discrepancies, and areas for improvement.
• Excellent written and verbal communication skills to effectively interact with clients, vendors, and internal teams.
• Proactive approach to identifying and resolving issues, with a focus on continuous improvement.
• Proficiency in medical billing software, auditing tools, and Microsoft Office Suite (Excel, Word, PowerPoint).

Work Traits:

• Strong organizational skills and ability to manage multiple tasks simultaneously.
• Experience in client-facing roles with a focus on delivering high-quality service.
• Familiarity with regulatory requirements and compliance standards in medical billing.

We offer a competitive and comprehensive compensation…