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Analyst, Bill Review Services
York Risk Services Group
Oxnard, CA, United States
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York Risk Services Group
is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of"America's Best Midsized Companies 2017"We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.
Job duties for this position center on the ability to provide payment recommendations for the billings from medical providers, for medically related services, delivered to workers who are injured on the job.
ESSENTIAL JOB RESPONSIBILITIES:
• Responsible for reviewing medical bills in accordance to the fee schedule, U&C and/or internal processing guidelines and for data accuracy
• Confirm and apply utilization review authorization/denial when applicable
• Utilize and interpret supporting documentation attached to medical bills from providers (reports, etc.)
• Complete a minimum standard of 130 reviews per day
• Reviews all bills in excess of a specific dollar threshold as determined by management
• Other duties as assigned
SUPERVISORY RESPONSIBILITIES:
SUPERVISION RECEIVED:
• This position reports to the Team Lead, Unit Manager or Director, Bill Review Services
SUPERVISION EXERCISED:
• NA
QUALIFICATIONS:
EDUCATION:
• BS/BA or Equivalent Work Experience/Education
EXPERIENCE:
• 1 to 2 years of professional work experience preferred
• Previous work in medical claims or medical billing
SKILLS/ABILITIES:
• Strong comprehension and analytical skills
• Ability to multi-task – based on the review types
• Ability to think outside the box
KNOWLEDGE:
• Official Medical Fee Schedule
• CPT Codes (Current Procedural Terminology)
• Medical Terminology