Senior Medical Bill Review & Cost Containment Analyst

AmTrust Financial Services, Inc.; Dallas (TX); Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical & Dental Plans

Life Insurance

401k Savings Plans

Health Care Flexible Spending

Dependent Care

Paid Time Off

Job summary

AmTrust Financial Services in Dallas, TX, seeks a Medical Bill Review Support Analyst to support the Medical Management department’s cost-containment goals. You will perform strategic and technical bill review to assist claim offices and adjusters, advancing workers' comp cost containment through analysis and process improvements.

This hybrid role involves auditing bills, developing fee-dispute processes, training staff, and maintaining relationships with internal and external stakeholders.

Qualifications

• Bachelor's Degree or equivalent experience.
• 2+ 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 including Excel, Access, Outlook, Word and other pertinent computer software packages.
• Able to work independently.
• Commitment to a high level of customer service.

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.

Skills

Analytical

Problem-solving

Decision-making

Verbal communication

Written communication

Education

Bachelor's Degree or equivalent experience

Tools

Excel

Access

Outlook

Word

Job description

AmTrust Financial Services in Dallas, TX, seeks a Medical Bill Review Support Analyst to support the Medical Management department’s cost-containment goals. You will perform strategic and technical bill review to assist claim offices and adjusters, advancing workers' comp cost containment through analysis and process improvements.

This hybrid role involves auditing bills, developing fee-dispute processes, training staff, and maintaining relationships with internal and external stakeholders.