Medical Bill Adjuster

Encova Mutual Insurance Group.; Charleston (WV); On-site; USD 44,000 - 70,000; Full time

Benefits offered by this job

Health, Dental & Vision Insurance

401(k) Retirement Plan with company 7%

Paid Time Off and Holidays

Flexible Work Arrangements - Hybrid/ro

Job summary

Encova Insurance is seeking a Medical Bill Adjuster to audit and process complex medical bills across locations with a hybrid (home and Charleston) work arrangement. The ideal candidate will verify coding accuracy, analyze medical records and ensure appropriate billing practices.

The role supports vendor reviews and cross‑functional collaboration. Qualified applicants have a degree and at least three years of medical billing or coding experience, plus coding certifications preferred.

Qualifications

• Associate or bachelor’s degree preferred; commensurate experience may be considered.
• Minimum of three years of experience in medical coding or medical bill processing.
• Certification in medical coding (AAPC or AHIMA) strongly preferred.
• Strong attention to detail and accuracy in coding and billing.
• Extensive knowledge of medical billing, ICD-10, CPT-4, DRG and HCPCS coding.
• Comprehensive understanding of medical invoices and forms.

Responsibilities

• Process medical invoices per pre-determined quota and ensure relation to compensable injury.
• Research medical records to determine appropriate coding and billing.
• Audit and process inpatient hospital bills and higher‑dollar claims.
• Review invoices for correct coding and modifier usage.
• Discuss billing matters with providers, claims adjusters and customers.
• Prepare reports and analyze data related to vendor reviews.
• Identify training needs and support staff with process improvements.
• Perform system testing as needed.

Skills

Medical billing knowledge

Attention to detail

Analytical thinking

Communication skills

Prioritize and manage workload

Education

Associate or Bachelor's degree

Professional coding certification (AAPC/AHIMA)

Tools

ICD-10 coding

CPT-4 coding

DRG knowledge

HCPCS coding

Job description

The salary range for this job posting is $43,950.00 - $70,319.00 annually + bonus + benefits. Pay Type: Hourly The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process.

Encova Insurance is seeking a Medical Bill Adjuster. The ideal candidate will reside within a reasonable commuting distance of our Charleston, West Virginia office and be able to work a hybrid schedule. However, we are also open to highly qualified candidates who reside in any state where Encova is authorized to employ associates, as listed in this posting, and who wish to work remotely from a home-based office.

Unique residence requirements are listed in each job posting, please review closely for details. Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes: Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.

JOB OBJECTIVE

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 Insurance conducts business.

ESSENTIAL FUNCTIONS

• 1. Process medical invoices based on a pre‑determined quota.
• 2. Ensure bills are related to compensable injury.
• 3. Research medical records to determine appropriate coding.
• 4. Audit and process inpatient hospital bills.
• 5. Audit and process higher‑dollar claims.
• 6. Audit high‑level evaluation and management bills for appropriate billing.
• 7. Review invoices for correct coding and correct usage of modifiers.
• 8. Approve additional units for payment for certain CPT/HCPCS codes.
• 9. Discuss billing matters with medical providers, claims adjuster, and customers.
• 10. Identify vendor trends and training needs and make recommendations accordingly.
• 11. Prepare reports and compile comprehensive data relating to the vendor review unit.
• 12. Analyze and manipulate report data.
• 13. Consult as needed with other staff regarding training needs.
• 14. Perform system testing as needed.

OTHER FUNCTIONS

• 1. Nonessential functions: other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES

• 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 either AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association) is strongly preferred.
• Strong attention to detail.
• Extensive knowledge of medical billing, ICD-10, CPT-4, DRG and HCPCS coding.
• Comprehensive understanding of medical invoices and forms.
• Effective computer skills.
• Ability to effectively prioritize and carry out work assignments.
• Strong communication skills.
• Ability to use and apply basic math skills.
• Understanding of Preferred Provider Organization (PPO).
• Extensive knowledge of medical terminology.
• Excellent data entry skills.

This position has been evaluated in accordance with the Americans with Disabilities Act. Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it. This description reflects the nature and level of work performed by associates in this position. It is not an all-inclusive inventory of duties, responsibilities and qualifications required. It provides an accurate overview of the work and skills needed to perform this position. Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.

READY TO JOIN OUR TEAM?

At Encova Insurance, we firmly believe that our associates drive our company's success by delivering unrivaled service to our customers. With success in mind, we make an ongoing effort to provide an environment that offers challenging, stimulating, and financially rewarding opportunities. Join us to discover a work experience where you can learn and grow to your fullest potential.

WHAT YOU CAN EXPECT FROM US

In addition to a competitive compensation package, we offer a comprehensive benefits package designed to support the well‑being and growth of our associates. Available benefits (subject to any policy or plan changes) include, but are not limited to:

• Health, Dental & Vision Insurance
• Company-provided life and income protection plans
• Eligibility to participate in a company incentive bonus program
• 401(k) Retirement Plan - 100% company match up to 7% on annual salary
• Paid Time Off, Paid Holidays, and Floating Holidays
• Flexible Work Arrangements - Hybrid and remote depending on the role

We believe that happy, healthy associates are the foundation of great work. Join us and thrive both professionally and personally. Encova Insurance is an EOE/E‑Verify employer.

COMPANY CULTURE

At Encova our associates are the heart of our business. Our exceptional culture makes it a special place to work and gives us a unique advantage. Building and sustaining this culture requires intentional effort from everyone in the company. We believe that achieving results and building trust are interrelated. Through connection, character and competence, we build trusting relationships with associates, agents and policyholders to achieve excellent results. Through our collaborative team structure we find professional and personal growth. We never stop learning and always seek to improve ourselves. At Encova, we know that inclusion and belonging foster our competitive edge by giving voice to every individual’s unique talent and perspective; and we believe that when a condition of equity exists, all associates can contribute to the fullest extent of their knowledge, skills and ability.