Job Description

Job Purpose:

We are looking for a detail-oriented professional to manage manual processes for applying PPO guidelines to medical bills efficiently and accurately.

Key Responsibilities:

Provider Identification: Determine if providers are participating or non-participating when automated systems cannot make this determination.
PPO Guideline Application: Accurately apply PPO guidelines to bills that match participation criteria when automated re-pricing is not feasible.
Communication:
Collaborate with clients and internal Bill Review staff via email or phone to request necessary bill images or documentation to correctly apply PPO discounts.
Address keying errors or discrepancies by requesting corrections to ensure accurate PPO discount application.
Engage with the PPO Application team through email, phone, or in person to address questions and concerns about specific bills or overall policies and procedures.
Rate Calculation: Use appropriate software and documents to calculate contracted rates, including AWP, Medicare, and applicable state or federal-mandated fee schedules.
Quality Assurance: Support the Senior PPO Application Specialist with quality assurance processes as needed.
Education and Qualifications:

Educational Background: High School Diploma required.
Experience and Skills:
Strong understanding of medical bill processes, including CPT Codes, Revenue Codes, Bill Types, ICD-9 and/or ICD-10 Codes, State Fee Schedules, UCR, and PPO.
Proficiency in using Windows-based software/applications.
Attention to detail with a high level of accuracy in typing.
Ability to review documentation and make informed decisions based on department policies and procedures.
Collaborative spirit and ability to work well with others.
Self-motivated and proactive approach to work.
Equal Opportunity Employment:

We are committed to providing equal employment opportunities to all employees and applicants, prohibiting discrimination and harassment of any kind. We ensure fair treatment for all, regardless of race, color, religion, age, sex, national origin, disability status, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by law. This commitment applies to all aspects of employment, including recruitment, hiring, promotion, termination, compensation, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour

Job Tags

Hourly pay, Full time,

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