The Bill Review Technical Analyst/ Auditor is responsible for determining appropriateness of charges via analysis of medical bills and corresponding supporting documentation. Technical expertise is utilized to enforce bill review edits, usual and customary standards, PPO discounts, client specific requirements and state fee schedules rules and regulations. Bills are audited to ensure accuracy of data entry and applied bill review edits, rules, and regulations.
Analyze bills to determine appropriateness of billed charges per bill review guidelines, rules, and regulations. Adjudicate bills through the application of technical expertise. Perform quality assurance audits on bills to ensure accuracy of data entry and application of bill review usual and customary guidelines, fee schedule rules and regulations and clinical edits. Process provider appeals and answer provider inquiry calls.
Knowledge & Skills
- Minimum five years’ workers’ compensation bill review experience
- Excellent verbal and written communication skills
- Proficient 10 key and data entry skills
- Ability to assist team members to develop knowledge and understanding of bill review practice
- Knowledge of CPT, medical terminology, ICD coding, clinical edits, DRG, NDC codes, and HCPC coding
- Knowledge of state fee schedules, usual and customary bill review processing, and PPO adjudication
- Strong time management and organizational skills
- Provider Inquiry and client relations experience
- Excellent phone skills
Ability to work well with a team or individually