EXCITING JOB OPPORTUNITY with a rapidly growing organization. This role is an amazing opportunity to grow and diversify your career within the healthcare arena. We will provide on the job training!
ABOUT THE COMPANY:
Nexus is dedicated to connecting quality physicians with the outcome needs of our partners in the health and legal industries. The heart of our drive for quality and excellence rests in our unflinching integrity; we bend over backwards to provide the best possible service but will never bend our integrity. Nexus realizes that behind the paperwork and reports, there are people; mothers, fathers, sisters, brothers, sons, and daughters. These are people in need of the best, most accurate, medical care possible and we are tasked with ensuring they receive it in a cost-effective manner. We offer competitive compensation and fantastic benefits. You’ll also find plenty of options for professional development and advancement with us as this position allows you to come in and learn our unique approach at offering healthcare cost management solutions. If this sounds like the kind of career move you’ve wanted to make, and if you meet our qualifications, we want to talk with you!
WHAT WE LOOK FOR:
Ideal candidate is a highly motivated and dynamic individual that thrives in a fast-paced environment.
Under moderate supervision, responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business within both Worker’s Compensation and Commercial Health arenas. This would include analyzation for fee schedule or usual and customary application as well as PPO interface while meeting contractual client requirements.
Knowledge and Abilities Requirements:
· Current knowledge of utilization review processes and managed care
- Knowledge of state-based fee schedules
- Strong knowledge of Medical Terminology and CPT/ICD-9/ICD-10 coding
· Ability to identify trends through analysis of practices to improve the overall utilization of resources and cost containment
· Ability to communicate those trends found through analytical study using a variety of reporting mediums
· Ability to work collaboratively and independently while meeting productivity standards.
· Ability to work in a high production environment while meeting productivity and quality standards.
· Ability to represent Utilization Management in organizational committees as assigned
· Excellent relationship management skills, including a high degree of professional demeanor and non-aggressive assertiveness
· Demonstrated ability to problem solve complex, multifaceted situations
· Ability to engage easily in abstract thought
· Strong organizational and task prioritization skills
· Strong analytical, numerical and reasoning abilities
· Well-developed interpersonal skills. Ability to get along with diverse personalities. Tactful, mature.
· Ability to establish credibility and be decisive – but able to recognize and support the organization’s preferences and priorities
· Results oriented with the ability to balance other business considerations
· Knowledgeable of multi state workers’ compensation systems
· Computer literacy on Microsoft Office products and data base programs
· Ability to construct grammatically correct reports using standard medical terminology
· Must have a track record of producing work that is highly accurate, demonstrating attention to detail, and reflecting well on the organization.
Education and Experience:
- High School Diploma or equivalent
- AAPC Coding Certification (CPC required, CIC preferred)
- ICD-9, ICD-10, PCS/HCPS/CPT, MS-DRG, and Geographical codes and NCQA regulatory compliance guidelines.
- 95th percentile
- RAC review and auditing
- Proficiency as a Specialty Medical Bill Reviewer with two or more years previous experience in medical bill review (workers’ compensation is a plus)
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All Nexus employees may be required to perform duties outside of their normal responsibilities from time to time, as needed.