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Medical Bill Coordinator – Remote
Sedgwick
- Springfield, Missouri, United States
- Springfield, Missouri, United States
About
Essential Functions and Responsibilities
Processes bills in accordance with multi-state schedules, rules, regulations, and guidelines.
Applies PPO contract discounts to bills.
Reviews operative reports to determine if surgery services were appropriately billed.
Reviews complex medical, legal and consult services.
Contacts client or facility to obtain additional or missing information.
Handles provider appeals where appropriate to fee schedule and contractual disputes.
Communicates internal issues to management.
Assists bill review team lead with workflow management, coaching and mentoring of staff.
Assists with process, procedure and system training for new staff.
Additional Functions and Responsibilities
Performs other duties as assigned.
Supports the organization’s quality program(s).
Travel as required.
Qualifications Education & Licensing High School diploma or GED required.
Experience Two (2) years workers’ compensation and/or bill review experience or equivalent combination of education and experience required to include provider appeals experience. PPO re‑pricing, surgery review, by report and RNE review preferred. Two (2) years of experience with complex medical, legal, and consult review preferred.
Skills & Knowledge
Knowledge of re‑pricing rules and guidelines
Knowledge of medical terminology, anatomy and surgical terms
Knowledge of multiple state jurisdictional regulations and rules
Knowledge of Fee Schedules, Rules, and U&c Guidelines
Knowledge of CPT/ICD9
PC literate, including Microsoft Office products
Leadership skills and ability to motivate others
Strong verbal and written communication skills
Strong interpersonal skills
High level of accuracy and attention to detail
Ability to multi‑task and function in high volume area
Ability to handle deadlines and proactively problem solve
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
Work Environment When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Physical Computer keyboarding, travel as required.
Auditory/Visual Hearing, vision and talking.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
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Languages
- English
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