Bill Reviewer III - Rocklin, CA (Contract - Hybrid)

Johnson Service Group, Inc.; Rocklin (CA); Sur place; USD 55 000 - 77 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision insurance

Life insurance

Short-term disability

401(k)

Weekly pay

Résumé du poste

Johnson Service Group is seeking a Bill Reviewer III for an onsite contract role in Rocklin, CA. The candidate will audit and process medical bills, applying CPT and ICD coding and fee schedules to determine proper reimbursement.

The position requires strong data entry skills, familiarity with workers’ compensation billing, and the ability to work under production quotas while maintaining quality and accuracy. This contract role offers timely weekly pay and benefits through JSG.

Qualifications

• High school diploma or GED required; 1 year data entry/medical billing experience; 2 years bill review in workers’ comp preferred.
• Must be proficient in CPT and ICD coding and familiar with workers’ compensation fee schedules.
• Strong attention to detail and ability to work under production quotas.

Responsabilités

• Code medical bills into the system with speed and accuracy.
• Screen for appropriateness and medical necessity of services.
• Determine reimbursement using fee schedules and repricing rationale.
• Flag problem bills to BR supervisor and communicate with clients/providers.
• Price hospital and surgery bills to applicable fee schedules; process reconsideration requests.

Connaissances

Medical billing

CPT coding

ICD9/ICD10 coding

Data entry

Communication

Attention to detail

Formation

High school diploma or GED

Outils

Word Processing

Spreadsheet

Database software

Description du poste

Bill Reviewer III - Rocklin, CA (Contract) Onsite pay rate range $40/hour - $55.55/hour

Summary: Under limited supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers’ compensation fee schedule by performing the following duties.

Essential Duties and Responsibilities:

• Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output.
• Performs preliminary screening for appropriateness and medical necessity of services rendered.
• Uses CPT and ICD9/ICD10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational.
• Flags any problem bills to the BR supervisor.
• Communicates with clients and/or providers to clarify information.
• Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers.
• Ability to price hospital and surgery bills to applicable fee schedules.
• Ability to process reconsideration requests as assigned.
• May specialize in state specific or client specific areas of responsibility.
• May assist is answering provider calls.

Competency:

• Design - Demonstrates attention to detail.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions.
• Team Work - Supports everyone's efforts to succeed.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers’ comp environment.

Language Skills:

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Knowledge Skills:

Strong knowledge of CPT and ICD9/ICD10 coding and workers compensation fee schedules. Must be familiar with workers’ compensation regulations and have good comprehension of company software system process.

Math Skills:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability:

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills:

To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software.

Certificates and Licenses:

Must have Medical Bill Reviewer Designation – 40 hour initial certification plus continuing education hours of 16 hours every 2 years.

Supervisory Responsibilities:

This job has no supervisory responsibilities.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to work and eight-hour shift, sit for long periods during the day, type or work at a keyboard most of the day, and read a video display terminal for long periods of time.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Requirements Competency:

• Design - Demonstrates attention to detail.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions.
• Team Work - Supports everyone's efforts to succeed.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Excellent oral and written communication skills.

Education and/or Experience:

High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers’ comp environment.

JSG offers medical, dental, vision, life insurance options, short-term disability, 401(k), weekly pay, and more.

Johnson Service Group (JSG) is an Equal Opportunity Employer.

JSG provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, marital status, protected veteran status, or any other characteristic protected by law.