Medical Bill Review II, Support

AmTrust Financial Services, Inc.; Boca Raton (FL); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Medical & Dental Plans

Life Insurance, including eligible/spo

Health Care Flexible Spending

Dependent Care

401k Savings Plans

Paid Time Off

Job summary

AmTrust Financial Services is seeking a Medical Bill Review Support Analyst to join the Medical Management team. You will provide strategic and technical bill review to assist claim offices and adjusters, supporting cost containment and improving billing accuracy for workers' compensation cases.

The role involves plan, execute, and oversee audits, develop fee dispute processes, and track savings. Hybrid work options are available from Boca Raton, FL or Dallas, TX, with opportunities to impact

Qualifications

• Bachelor's degree or equivalent experience.
• 2+ years of claims experience with increasing responsibility.
• Knowledge of Workers Compensation Fee Schedule Guidelines, Medical Billing, and Medical Terminology.
• Experience in bill processing platforms and claim systems.
• Working knowledge of medical jargon and anatomy preferred.
• Excellent verbal and written communication skills.
• Excellent computer skills including Excel, Access, Outlook, Word and other pertinent software.
• Ability to work independently.
• Commitment to a high level of customer service.

Responsibilities

• Plan, execute, and oversee bill audits related to state fee disputes.
• Develop and monitor fee dispute processes and programs.
• Perform fee dispute reviews and submit formwork related to re-pricing and network vendors.
• Review and audit bills to verify correct billing practices and contractual rates.
• Develop cost containment strategies in response to billing practices.
• Responsible for financial recovery and reporting of cost savings.
• Track financial recovery and report cost savings.
• Maintain and develop relationships with internal claims staff and external bill pricing vendors.

Skills

Verbal Communication

Written Communication

Analytical Thinking

Education

Bachelor's degree or equivalent experience

Tools

Excel

Access

Outlook

Word

Job description

The Medical Bill Review Support Analyst supports the Medical Management department's key goals of enhancing cost containment. Provides strategic and technical bill review to assist claim offices and adjusters. Accomplishes Managed Care objectives by working processes; planning and evaluating adjuster activities and Medical bill review activities. Technical abilities and industry-specific knowledge to review Workers Compensation medical bills.

The Medical Bill Review Support Analyst supports the Medical Management department's key goals of enhancing cost containment. Provides strategic and technical bill review to assist claim offices and adjusters. Accomplishes Managed Care objectives by working processes; planning and evaluating adjuster activities and Medical bill review activities. Technical abilities and industry-specific knowledge to review Workers Compensation medical bills.

Note, this is a hybrid opportunity out of our Dallas, TX or Boca Raton, FL office.

Responsibilities

Plan, execute, and oversee bill audits related to state fee disputes.

• Assist in the development of fee dispute processes, including overall management and monitoring programs.
• Perform fee dispute reviews and submit relevant formwork related to re-pricing and network vendors.
• Review and audit bills to verify correct billing practices and contractual rates.
• Ongoing development of cost containment strategies in response to noted billing practices.
• Responsible for all financial recovery and reporting of cost savings.
• Track financial recovery and report cost savings.

Perform a wide range of administrative duties related to the quality control and quality assurance of processes.

• Develop or update procedures for capture, investigation, and documentation of product complaints.
• Monitor risk-management procedures, maintain problem logs, and report issues to managers and product developers.
• Prepare written communications such as letters, memos, and emails.

Maintain and develop relationships with both internal claims staff and external bill pricing vendors to achieve goals

• Develop and manage agendas for internal claim office meetings related to fee disputes.
• Involvement in training material and deliver trainings.
• Track and promptly investigate material issues, particularly those with a significant impact on the company's financial, operational, and reputational standing.

Excellent Analytical, Problem-solving, And Decision-making Skills.

• Review, tabulate, and enter data into a variety of systems.
• Develop charts, graphs, and tables in Excel and PowerPoint.
• Analyze and report new or recurring problems in workflows.
• Manage trends across various areas and document issues to detail areas for workflow improvement.

Qualifications

• Bachelor's Degree or equivalent experience
• 2 or more years of claims experience in positions of increasing responsibility
• Knowledge of Workers Compensation Fee Schedule Guidelines, Medical Billing, and Medical Terminology
• Experience in bill processing platforms and claim systems
• Working knowledge of medical jargon and anatomy preferred
• Excellent verbal and written communication skills
• Excellent computer skills required including Excel, Access, Outlook, Word and other pertinent computer software packages.
• Able to work independently
• Commitment to a high level of customer service

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities.

• Medical & Dental Plans
• Life Insurance, including eligible spouses & children
• Health Care Flexible Spending
• Dependent Care
• 401k Savings Plans
• Paid Time Off

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.