Remote Bill Review Specialist – Workers' Comp Claims

Ethos Risk Services; United States; Remote; USD 30,000 - 41,000; Full time

Benefits offered by this job

Paid Time Off

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Short-Term Disability Insurance

Long-Term Disability Insurance

401(k) Matching

Employee Referral Bonus Program

Job summary

Ethos Risk Services is hiring a full-time Bill Review Specialist (REMOTE) to review and adjudicate workers' compensation medical bills in a 100% remote U.S.-based role. The position requires strong analytical abilities, meticulous attention to detail, and experience with state fee schedules, CPT/ICD-10/HCPCS, and reimbursement methodologies.

You will interact with providers, draft determinations, and collaborate with the Account Management team to resolve billing issues while ensuring regulatory

Qualifications

• Requires 3–5 years of workers' compensation bill review experience.
• Knowledge of CPT, ICD-10, HCPCS is required.
• Experience with state fee schedules, PPO contracts, and reimbursement methodologies.
• Experience applying multi-state workers' compensation fee schedules and regulations (preferred).
• Experience researching complex reimbursement issues and provider appeals (preferred).
• Experience managing provider appeals, reconsiderations and billing disputes (preferred).

Responsibilities

• Analyze Medical Bills: review and adjudicate hospital, ASC, DME, pharmacy, transportation, home health and other bill types for accuracy and compliance.
• Research Provider Appeals: interpret fee schedules, reimbursement methodologies, regulations, and client guidelines.
• Prepare Reimbursement Determinations: draft clear written communications explaining payments and methodologies.
• Communicate with Providers: respond to inquiries via phone and written correspondence.
• Support Cross-Functional Teams: partner with Account Management and internal stakeholders to resolve billing issues and support clients.

Skills

Analytical

Detail-oriented

Multistate knowledge

CPT/ICD-10/HCPCS knowledge

Education

High school diploma or equivalent

Associate's degree or higher preferred

Tools

Conduent Strataware

CompIQ

Job description

Ethos Risk Services is hiring a full-time Bill Review Specialist (REMOTE) to review and adjudicate workers' compensation medical bills in a 100% remote U.S.-based role. The position requires strong analytical abilities, meticulous attention to detail, and experience with state fee schedules, CPT/ICD-10/HCPCS, and reimbursement methodologies.

You will interact with providers, draft determinations, and collaborate with the Account Management team to resolve billing issues while ensuring regulatory