[Hiring] Medical Bill Coordinator @Sedgwick

Role Description

The primary purpose of the Medical Bill Coordinator is to review hospital and professional medical bills from providers, including complex hospital, surgical, high-level evaluation and management codes, and/or technical bills.

• Processes bills in accordance with multi-state schedules, rules, regulations, and guidelines.
• Applies PPO contract discounts to bills.
• Reviews operative reports to determine if surgery services were appropriately billed.
• Reviews complex medical, legal, and consult services.
• Contacts client or facility to obtain additional or missing information.
• Handles provider appeals where appropriate to fee schedule and contractual disputes.
• Communicates internal issues to management.
• Assists bill review team lead with workflow management, coaching, and mentoring of staff.
• Assists with process, procedure, and system training for new staff.

Additional functions and responsibilities include:

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travel as required.

Qualifications

• High School diploma or GED required.
• Two (2) years workers' compensation and/or bill review experience or equivalent combination of education and experience required, including provider appeals experience.
• PPO re-pricing, surgery review, by report, and RNE review preferred.
• Two (2) years of experience with complex medical, legal, and consult review preferred.
• Knowledge of re-pricing rules and guidelines.
• Knowledge of medical terminology, anatomy, and surgical terms.
• Knowledge of multiple state jurisdictional regulations and rules.
• Knowledge of Fee Schedules, Rules, and U&C Guidelines.
• Knowledge of CPT/ICD9.
• PC literate, including Microsoft Office products.
• Leadership skills and ability to motivate others.
• Strong verbal and written communication skills.
• Strong interpersonal skills.
• High level of accuracy and attention to detail.
• Ability to multi-task and function in a high-volume area.
• Ability to handle deadlines and proactively problem solve.
• Ability to work in a team environment.
• Ability to meet or exceed Performance Competencies.

Requirements

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
• Physical: Computer keyboarding, travel as required.
• Auditory/Visual: Hearing, vision, and talking.

Benefits

• Comprehensive benefits package including medical, dental, and vision.
• 401k and matching.
• PTO.
• Disability and life insurance.
• Employee assistance program.
• Flexible spending or health savings account.
• Other additional voluntary benefits.