Hybrid Medical Bill Auditor & Coding Specialist

Encova Insurance; Charleston (WV); Hybrid; USD 44,000 - 70,000; Full time

Benefits offered by this job

Health Insurance

Life and income protection

Bonus program

401(k) Retirement Plan - company match

Paid Time Off & Holidays

Flexible work arrangements

Job summary

Encova Insurance is seeking a Medical Bill Adjuster to research, audit and process moderately complex to complex medical bills for payment across all locations. This role determines the appropriateness of coding and services that require prior approval, and processes bills accordingly in a hybrid setup.

The ideal candidate has at least three years of medical billing/coding experience, a relevant degree, and a preferred medical coding certification.

Qualifications

• Associate or bachelor's degree from an accredited college or university is strongly preferred; commensurate experience may be considered.
• A minimum of three years of experience in medical coding or medical bill processing is required.
• Certification in medical coding from AAPC or AHIMA is strongly preferred.
• Strong attention to detail and excellent data entry skills.
• Extensive knowledge of medical billing, ICD-10, CPT-4, DRG and HCPCS coding.

Responsibilities

• Process medical invoices based on a pre-determined quota.
• Ensure bills are related to compensable injury.
• Research medical records to determine appropriate coding.
• 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 proper use of modifiers.
• Approve additional units for payment for certain codes.
• Discuss billing matters with providers, claims adjusters, and customers.
• Identify vendor trends and training needs and make recommendations.
• Prepare reports and compile data relating to the vendor review unit.
• Analyze and manipulate report data.
• Consult with staff regarding training needs.
• Perform system testing as needed.

Skills

Attention to detail

Communication skills

Medical billing knowledge

ICD-10/CPT-4/HCPCS coding

Data entry

Prioritization

Numerical/math aptitude

Education

Associate or bachelor's degree

Medical coding certification (AAPC/AHIMA)

Job description

Encova Insurance is seeking a Medical Bill Adjuster to research, audit and process moderately complex to complex medical bills for payment across all locations. This role determines the appropriateness of coding and services that require prior approval, and processes bills accordingly in a hybrid setup.

The ideal candidate has at least three years of medical billing/coding experience, a relevant degree, and a preferred medical coding certification.