Job Description

Purpose:
We're looking for a detail-oriented professional to manage the manual processes involved in applying PPO guidelines to medical bills. This role is key to ensuring that our processes are both timely and accurate.

Key Responsibilities:

Provider Identification: Determine whether a provider is participating or non-participating when the automated system cannot make this distinction.
PPO Guidelines Application: Accurately apply PPO guidelines to bills where a participation match has been made, especially when the automated re-pricing process is unable to do so.
Communication: Collaborate with clients and internal Bill Review teams via email or phone to:
Request necessary bill images or documentation to correctly apply a PPO discount.
Address keying errors or discrepancies and request necessary corrections.
Team Collaboration: Work closely with the PPO Application team through email, phone, or in person to resolve questions and concerns about specific bills or general procedures.
Rate Calculation: Use the appropriate software and documentation to calculate contracted rates, including calculations for AWP, Medicare, or any applicable state or federal-mandated fee schedules.
Quality Assurance: Support the Senior PPO Application Specialist in the QA process when needed.
Qualifications:

Education: High School Diploma required.
Experience and Skills:
Experience with medical bill processes and familiarity with CPT Codes, Revenue Codes, Bill Types, ICD-9 and/or ICD-10 Codes, State Fee Schedules, UCR, and PPO.
Proficiency in Windows-based software/applications.
Strong attention to detail and accuracy in typing.
Ability to review documentation and make informed decisions based on department policies and procedures.
A collaborative mindset and a desire to work well with others.
Self-motivation and the ability to take initiative.
Equal Employment Opportunity:

We are committed to providing equal employment opportunities to all employees and applicants. Discrimination or harassment of any kind based on 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 law is strictly prohibited. This policy applies to all aspects of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour

Job Tags

Similar Jobs