Bill Review Complex Analyst, Risk Management - Lakeland

Publix Super Markets; Lakeland (FL); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Employee stock ownership plan

Stock Purchase Plan

401(k) retirement savings plan

Group health, dental and vision plans

Paid Time Off

Paid Parental Leave

Short- and long-term disability ins

Tuition reimbursement

Free hot lunches

Job summary

Publix Super Markets is seeking a detail-oriented analyst to review and resolve medical billings for workers’ compensation claims. You will verify authorization, ensure fees align with schedules, and handle disputes with providers in a timely manner.

Responsibilities include communicating with vendors, managing customer service for risk management, and navigating state-specific reconsideration processes. A medical terminology or billing background is preferred, with strong attention to accuracy

Qualifications

• Associate’s degree
• 1-year general office experience with Windows-based programs
• Knowledge of CPT and ICD-9 codes
• Knowledge of multiple state Worker’s Compensation Fee Schedules for states Publix does business in
• Knowledge of Medical Terminology
• Initiative
• Planning and Organizing
• Stress-Tolerance
• Time Management
• Financial Acumen
• Detail Orientation
• Problem Solving
• Building Relationships
• Customer Focus
• Verbal Communication
• Written Communication
• Microsoft Word (Basic)
• Microsoft Excel (Basic)
• Microsoft PowerPoint (Basic)
• Microsoft Access (Basic)
• Availability to work weekends
• Availability to work holidays
• Availability to work extended hours

Responsibilities

• This position is responsible for reviewing and analyzing medical bills to confirm whether treatment rendered was authorized by the adjuster or medical case manager is appropriate for the type of injury sustained, and that the fees invoiced are standard and equitable, follow appropriate schedules and regulations, and align with previous contracted agreements.
• This position is responsible for manually reviewing and resolving issues on medical bills that are flagged as requiring more in-depth review, or which cannot otherwise be re-priced to the appropriate state workers’ compensation fee schedule by our automated medical bill review system (Smart Advisor).
• This position is responsible for communicating directly with vendors and medical providers that challenge the amount reimbursed. Disputes regarding medical billings are administered in accordance with the appropriate state mandated “Reconsideration Process,” as required by each individual state’s workers’ compensation rules and regulations, which contains stringent timelines. These challenges are typically received via telephone, fax, or in writing.
• This position is responsible for provide customer service activities to providers, Publix managers, and associates that contact Risk Management regarding the payment or non-payment of bills.

Skills

Verbal Communication

Written Communication

Detail Orientation

Time Management

Planning and Organizing

Stress-Tolerance

Customer Focus

Problem Solving

Building Relationships

Availability to work weekends

Availability to work holidays

Availability to work extended hours

Bilingual in English and Spanish

Microsoft Word (Basic)

Microsoft Excel (Basic)

Microsoft PowerPoint (Basic)

Microsoft Access (Basic)

Education

Associate’s degree

BS degree or certificate of completion of a medical terminology or medical billing program

National Certification for CPT Coding

Tools

Windows-based programs

SmartAdvisor/CEPV

Mitchell and RMX software systems

ODG

Medical billing software

Job description

Description
Primary Responsibilities:

• This position is responsible for reviewing and analyzing medical bills to confirm whether treatment rendered was authorized by the adjuster or medical case manager is appropriate for the type of injury sustained, and that the fees invoiced are standard and equitable, follow appropriate schedules and regulations, and align with previous contracted agreements.
• This position is responsible for manually reviewing and resolving issues on medical bills that are flagged as requiring more in-depth review, or which cannot otherwise be re-priced to the appropriate state workers’ compensation fee schedule by our automated medical bill review system (Smart Advisor).
• This position is responsible for communicating directly with vendors and medical providers that challenge the amount reimbursed. Disputes regarding medical billings are administered in accordance with the appropriate state mandated “Reconsideration Process,” as required by each individual state’s workers’ compensation rules and regulations, which contains stringent timelines. These challenges are typically received via telephone, fax, or in writing.
• This position is responsible for provide customer service activities to providers, Publix managers, and associates that contact Risk Management regarding the payment or non-payment of bills.

Description
Primary Responsibilities:

• This position is responsible for reviewing and analyzing medical bills to confirm whether treatment rendered was authorized by the adjuster or medical case manager is appropriate for the type of injury sustained, and that the fees invoiced are standard and equitable, follow appropriate schedules and regulations, and align with previous contracted agreements.
• This position is responsible for manually reviewing and resolving issues on medical bills that are flagged as requiring more in-depth review, or which cannot otherwise be re-priced to the appropriate state workers’ compensation fee schedule by our automated medical bill review system (Smart Advisor).
• This position is responsible for communicating directly with vendors and medical providers that challenge the amount reimbursed. Disputes regarding medical billings are administered in accordance with the appropriate state mandated “Reconsideration Process,” as required by each individual state’s workers’ compensation rules and regulations, which contains stringent timelines. These challenges are typically received via telephone, fax, or in writing.
• This position is responsible for provide customer service activities to providers, Publix managers, and associates that contact Risk Management regarding the payment or non-payment of bills.

Required Qualifications

• Associate’s degree
• 1-year general office with experience with Windows based programs
• Knowledge of CPT and ICD-9 codes
• Knowledge of multiple state Worker’s Compensation Fee Schedules for the states in which Publix does business in
• Knowledge of Medical Terminology
• Initiative
• Planning and Organizing
• Stress-Tolerance
• Time Management
• Financial Acumen
• Detail Orientation
• Problem Solving
• Building Relationships
• Customer Focus
• Verbal Communication
• Written Communication
• Microsoft Word (Basic)
• Microsoft Excel (Basic)
• Microsoft PowerPoint (Basic)
• Microsoft Access (Basic)
• Availability to work weekends (rare)
• Availability to work holidays (occasional)
• Availability to work extended hours (occasional)

Preferred Qualifications

• BS degree or certificate of completion of a medical terminology or medical billing program
• 1 year in medical or insurance services, with advanced knowledge of CPT and ICD-9 codes, and knowledge of medical terminology
• National Certification for CPT Coding
• Bilingual in English and Spanish
• Microsoft Word (Expert)
• Microsoft Excel (Advanced)
• Microsoft PowerPoint (Intermediate)
• Microsoft Access (Advanced)
• SmartAdvisor/CEPV
• ODG
• Mitchell and RMX software systems, or similar bill review software

Benefits Information

• Employee stock ownership plan that contributes Publix stock to associates each year at no cost
• An opportunity to purchase additional shares of our privately-held stock
• 401(k) retirement savings plan
• Group health, dental and vision plans
• Paid Time Off
• Paid Parental Leave
• Short- and long-term disability insurance
• Tuition reimbursement
• Free hot lunches (buffet-style) at facilities with a cafeteria
• Visit our website to see all of our benefits: https://jobs-beta.publix.com/benefits/

Year End Bonus

To reward associates for their contributions to the company for the calendar year, Publix provides a Holiday Bonus in November. In the first year of continuous employment the bonus is equal to 15 hours of pay, and in the second year of continuous employment the bonus is equal to one week’s pay if associate remains employed through issue date of the bonus check. In subsequent years, the bonus is equal to two weeks’ pay.

Additional Information

Your application may have additional steps that you will need to complete in order to remain eligible for consideration. Please be sure to monitor your email, including your spam folder, on a daily basis for critical, time-sensitive emails that could require action within 24-48 hours.Please do not use your Publix email address when applying. Once your application has been successfully submitted you will receive a confirmation email.For this position, Publix does not and will not file a petition or application with the USCIS or Department of State on behalf of any noncitizen for any immigration-related benefit to work and/or to continue to work in the United States, e.g., an H-1B or TN petition or permanent residence.