Job Description

Purpose
We are looking for a dedicated and detail-oriented professional to manage the manual processes of applying PPO guidelines to medical bills. Your work will be essential in ensuring that medical bills are handled accurately and efficiently.

Key Responsibilities

Identify whether a healthcare provider is participating or non-participating in PPO networks when our automated system can't make the determination.
Apply PPO guidelines accurately to medical bills where a participation match has been made but the automated process couldn't re-price them.
Communicate effectively with clients and our internal Bill Review team via email or phone to:
Request bill images or documentation needed to correctly apply PPO discounts.
Clarify any keying errors or discrepancies and request corrections.
Collaborate with the PPO Application team through email, phone, or in-person meetings to address questions or concerns regarding specific bills or general policies and procedures.
Utilize the appropriate software and documentation to calculate contracted rates, including AWP, Medicare, or relevant state or federal-mandated fee schedules.
Assist the Senior PPO Application Specialist with the quality assurance process when needed.
Education and Qualifications

High School Diploma required.
Experience with medical billing processes, including 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 typing accuracy.
Ability to review documentation and make informed decisions based on department policies and procedures.
Team-oriented with a desire to collaborate effectively with others.
Motivated self-starter with a commitment to accuracy and attention to detail.
Equal Employment Opportunity
We are committed to providing equal employment opportunities to all employees and applicants. Discrimination or harassment of any kind is strictly prohibited, regardless of 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. This policy applies to all aspects of employment, including recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour

Job Tags

Hourly pay, Full time,

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