|Employer:||Zenith Insurance Company
|Skills:||Work experience demonstrating knowledge of ICD-10 classifications,CPT codes,HCPCS,Workers’ Compensation State Fee Schedule and/or Medicare knowledge.
|Required Experience:||1 to 2 years
|Location:||Woodland Hills, CA
This position can be filled in our Orange, CA, Woodland Hills, CA or Sarasota, FL Branches.
Zenith is a team of Workers Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional.
Under general supervision, analyzes and audits medical bills from providers in order to determine appropriate reimbursement. Audits, analyzes, arranges and revises submitted information to determine reimbursement. Tracks issues and trends. Demonstrates an intermediate understanding of the area.
The essential functions of this position include, but are not limited to, the following:
• Responsible for review of Workers’ Compensation medical bills to ensure accurate and appropriate payment recommendations, according to State Fee schedules, guidelines and PPO Network pricing.
• Manage a bill processing assignment, which includes initial billing submissions. Use critical thinking and analytical reasoning to approve, modify and/or deny bills in accordance with state mandates and/or department guidelines. Review and interpret supporting documentation attached to medical billings, including review of claim information, to determine appropriate reimbursement.
• Audits and certifies potential duplicate bills and determines previous status of processing through close review and search of medical bills in the bill review system.
• Occasionally process bills requiring a secondary review, such as those submitted through the formal reconsideration process.
• Confirm and apply utilization review determinations as part of medical bill reviews when applicable.
• Determine and forward bills to the MAT team that may be eligible for provider negotiation based on evaluation of billed services, pricing and payment guidelines.
• Participate in regular training modules and educational forums to deepen proficiency in bill processing, to prepare for more complex and diverse bill review assignments.
• Communicate any system, bill review, billing anomaly and procedural issues to departmental supervisor.
• Meets established production and quality goals.
• Performs other job related duties as assigned.
Education, Skills and Experience Requirements
• High school diploma or equivalent required.
• California Medical Bill Reviewer designation required within 1st year
• Minimum one year of medical bill review (or related) experience, in Workers Compensation, Medical/Health Care, Insurance Industry or Medical Coding/Billing. Demonstrated knowledge of medical terminology, anatomy and surgical/medical procedure terms.
• Work experience demonstrating knowledge of ICD-10 classifications, CPT codes, HCPCS, Workers’ Compensation State Fee Schedule and/or Medicare knowledge.
• Demonstrated proficiency with billing software, technology and system driven workflows.
• Demonstrated familiarity with a broad type of medical billing forms.
• Ability to interpret medical records to support the appropriate billed services.
• Strong verbal and written communication skills.
• Ability to work with little direction and maintain long periods of focused concentration.
• Strong prioritization and time management skills.
• Demonstrated basic mathematical aptitude.
• Flexible and adaptable to a growing and changing environment.
• Self-motivated to keep up with production and quality goals.
*Qualifications may warrant placement in a different job level*