Medical Bill Review II, Support

AmTrust Financial Services Inc.; Dallas (TX); Hybrid; USD 55,000 - 75,000; Full time

Job summary

AmTrust Financial Services in Dallas, TX is seeking a Medical Bill Review Support Analyst to strengthen cost containment within the Medical Management department. You will provide strategic and technical bill review to assist claim offices and adjusters, focusing on workers' compensation medical bills.

This hybrid role involves planning, auditing, and improving fee dispute processes, with emphasis on data-driven cost recovery and reporting.

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 terminology.
• Experience in bill processing platforms and claim systems.
• Medical jargon knowledge preferred.
• Excellent verbal and written communication skills.
• Strong computer skills: Excel, Access, Outlook, Word.
• Ability to work independently and maintain high customer service standards.

Responsibilities

• Plan, execute, and oversee bill audits related to state fee disputes.
• Develop fee dispute processes and monitor programs.
• Perform fee dispute reviews and re-pricing documentation with vendors.
• Audit bills to verify correct billing practices and rates.
• Develop cost containment strategies and report cost savings.
• Handle administrative duties for quality control and QA of processes.
• Monitor risk-management procedures and document issues.
• Prepare communications such as letters, memos, and emails.
• Maintain relationships with internal claims staff and external vendors.
• Lead internal claim office meetings on fee disputes and deliver trainings.
• Track financial recovery and analyze workflow problems for improvements.
• Analyze data, create charts/tables in Excel/PowerPoint, and report trends.

Skills

Claims experience

Medical terminology

Verbal communication

Written communication

Customer service

Independent work

Problem solving

Education

Bachelor's degree or equivalent experience

Tools

Excel

Access

Outlook

Word

Bill processing platforms

Claim systems

Job description

Overview

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 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. Our benefits include: 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.