|Required Experience:||3 to 4 years
|Location:||400 Quarrier Street Charleston 25301, WV, US
This role will work full time in the Encova Charleston, WV office.
The Medical Bill Adjuster researches, audits and
processes moderately complex to complex medical bills for payment. This position determines the appropriateness
of procedural coding, diagnosis and services that require prior approval. The Medical Bill Adjuster processes bills for
all locations in which Encova conducts business.
Education and Experience:
- High school diploma required.
- Associate or Bachelor’s degree from an accredited
college or university is strongly preferred; commensurate experience may
- A minimum of three years of experience in medical
coding or medical bill processing is required.
- Certification in medical coding from either AAPC
(American Academy of Professional Coders) or AHIMA (American Health
Information Management Association) is strongly preferred.
The items listed are essential functions of
the position unless otherwise stated
- Process medical invoices, based on a pre-determined
- Ensure bills are related to compensable injury.
- Research medical records to determine appropriate
- Audit and process inpatient hospital bills.
- Audit and process higher-dollar claims.
- Audit high-level evaluation and management bills
for appropriate billing.
- Review invoices for correct coding and correct
usage of modifiers.
- Approve additional units for payment for certain
- Discuss billing matters with medical providers,
claims adjuster, and customers.
- Identify vendor trends and training needs and
make recommendations accordingly.
- Prepare reports and compile comprehensive data
relating to the vendor review unit.
- Analyze and manipulate report data.
- Consult as needed with other staff regarding
- Perform system testing as needed.
- Nonessential functions: other duties as assigned.
- Strong attention to detail.
- Extensive knowledge of medical billing, ICD-10,
CPT-4, DRG and HCPCS coding.
- Comprehensive understanding of medical invoices
- Effective computer skills.
- Ability to effectively prioritize and carry out work
- Strong computer skills.
- Strong communication skills.
- Ability to use and apply basic math skills.
- Understanding of Preferred Provider Organization
- Extensive knowledge of medical terminology.
- Excellent data entry skills.