Medical Bill Coordinator

Sedgwick; Tallahassee (FL); Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Remote work option

Job summary

Sedgwick, a leading global risk and claims partner, seeks a Medical Bill Coordinator to review hospital and professional bills, including high-level evaluation and management coding. You will ensure accuracy against multi-state schedules, apply PPO discounts, and verify surgeries and complex services.

Ideal applicants have a high school diploma and 2 years of workers' comp or bill review experience, with strong communication and detail orientation.

Qualifications

• High School diploma or GED required.
• Two years of workers' compensation or bill review experience, including provider appeals preferred.
• Knowledge of re-pricing rules, medical terminology, and CPT/ICD9 codes.

Responsibilities

• Process hospital and professional bills per state rules and guidelines.
• Apply PPO contract discounts to bills and review operative reports.
• Review complex medical, legal, and consult bills.
• Contact client or facility to obtain missing information.
• Assist with staff training and workflow management.

Skills

Billing terminology

CPT/ICD9 knowledge

Verbal/written communication

Microsoft Office

Multi-tasking in high volume

Attention to detail

Team leadership

Education

High School diploma or GED

Tools

PC literate

Office software

Job description

Telecommuter FL

R78047

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Medical Bill Coordinator

PRIMARY PURPOSE : To review hospital and professional medical bills from provider including complex hospital, surgical, high level evaluation and management codes, and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Processes bills in accordance with multi state schedules, rules, regulations, and guidelines.
• Applies PPO contract discounts to bills.
• Reviews operative reports to determine if surgery services were appropriately billed.
• Reviews complex medical, legal and consult services.
• Contacts client or facility to obtain additional or missing information.
• Handles provider appeals where appropriate to fee schedule and contractual disputes.
• Communicates internal issues to management.
• Assists bill review team lead with workflow management, coaching and mentoring of staff.
• Assists with process, procedure and system training for new staff.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travel as required.

QUALIFICATIONS

Education & Licensing

High School diploma or GED required.

Experience

Two (2) years workers' compensation and/or bill review experience or equivalent combination of education and experience required to include provider appeals experience. PPO re-pricing, surgery review, by report and RNE review preferred. Two (2) years of experience with complex medical, legal, and consult review preferred.

Skills & Knowledge

• Knowledge of re-pricing rules and guidelines
• Knowledge of medical terminology, anatomy and surgical terms
• Knowledge of multiple state jurisdictional regulations and rules
• Knowledge of Fee Schedules, Rules, and U&C Guidelines
• Knowledge of CPT/ICD9
• PC literate, including Microsoft Office products
• Leadership skills and ability to motivate others
• Strong verbal and written communication skills
• Strong interpersonal skills
• High level of accuracy and attention to detail
• Ability to multi-task and function in high volume area
• Ability to handle deadlines and proactively problem solve
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $.19.00. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com