Job Description

Job Description

Job Description

MEDICAL BILL REVIEWER-100% REMOTE ( EST or CST time zone )

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

PURPOSE: Responsible for handling manual processes involved in applying PPO guidelines to medical bills in a timely and accurate manner.

ESSENTIAL JOB FUNCTIONS

• Identify a provider as participating or non-participating when the automated matching process is not able to make that determination.
• Accurately apply PPO guidelines to those bills where a participation match has been made when the automated re-pricing process is not able to apply the guidelines.
• Communicate with clients and internal Bill Review staff via e-mail or phone:
  1. To request bill images or documentation when necessary to properly apply a PPO discount.
  2. To question keying errors or discrepancies and request corrections to properly apply a PPO discount.
• Communicate with the PPO Application team via e-mail, phone, or in person regarding questions and concerns about specific bills or general policies and procedures.
• Utilize appropriate software and documents to calculate contracted rates, which may include, but is not limited to the calculation of AWP, Medicare, or applicable state or federal-mandated fee schedule.
• Assist the Senior PPO Application Specialist with the QA process when necessary.

EDUCATION: High School Diploma Required

REQUIRED EXPERIENCE AND SKILLS:

• Experience with medical bill processes, including familiarity with CPT Codes, Revenue Codes, Bill Types, ICD-9 and/or ICD-10 Codes, State Fee Schedules, UCR, and PPO.
• Experience working with Windows-based software /applications.
• Ability to type with accuracy.
• Ability to review documentation and make decisions on how to proceed based on department policies and procedures.
• Desire to work well with others.
• Motivation to be a self-starter.

EEOC Statement:

Medlogix provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

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