Bill Review Analyst
Zenith Insurance Company (United States)
full-time
Posted on:
Location Type: Hybrid
Location: Woodland Hills • California • Florida • United States
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Salary
💰 $43,996 - $54,995 per year
About the role
- Reviews Workers’ Compensation medical bills to ensure accurate and appropriate payment recommendations, according to State Fee schedules, guidelines and PPO Network pricing
- Approves, modifies, and/or denies bills in accordance with state mandates and/or department guidelines
- Reviews and interprets supporting documentation attached to medical billings, including review of claim information, to determine appropriate reimbursement
- Audits and certifies potential duplicate bills and determines previous status of processing through close review and search of medical bills in the bill review system
- Confirms and applies utilization review determinations as part of medical bill reviews when applicable
- Determines and forwards bills to the MAT team that may be eligible for provider negotiations based on evaluation of billed services, pricing, and payment guidelines
- Manages a bill processing assignment, which includes initial billing submissions
- Tracks issues and trends
- Occasionally processes bills requiring a secondary review, such as those submitted through the formal reconsideration process
- Participates and completes required training to enhance proficiency in bill review and processing
- Communicates any system, bill review, billing anomaly and procedural issues to departmental supervisor
- Meets established production and quality goals
- Responds positively to direction and feedback on performance
- Works productively and harmoniously with others on a consistent basis
- Performs other job related duties as assigned
Requirements
- High School Diploma or equivalent combination of education and experience required
- Bachelor’s Degree or equivalent combination of education and experience preferred
- 1-3 years medical bill review (or related) experience, in Workers Compensation, Medical/Health Care, Insurance Industry or Medical Coding/Billing
- Knowledge of ICD-10 classifications, CPT codes, HCPCS, Workers' Compensation State Fee Schedules and/or Medicare knowledge required
- Demonstrated knowledge of medical terminology, anatomy and surgical/medical procedure terms
- Demonstrated proficiency with billing software, technology and system driven workflows
- Strong verbal and written communication skills
- Ability to work with little direction and maintain long periods of focused concentration
- Strong prioritization and time management skills
Benefits
- Medical, Dental and Vision Insurance
- Flexible Spending Accounts
- Paid Parental Leave
- Life, AD&D and Disability Insurance
- 401(k), Employee Share Purchase Plan (ESPP)
- Education and Training Reimbursement
- Paid Leave: 3 weeks/year
- Vacation, 2 weeks/year
- Sick Leave: 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays
- Employee Assistance Program (EAP)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical bill reviewICD-10 classificationsCPT codesHCPCSWorkers' Compensation State Fee SchedulesMedicare knowledgemedical terminologyanatomysurgical proceduresbilling software
Soft Skills
verbal communicationwritten communicationprioritizationtime managementability to work independentlyfocused concentrationresponsiveness to feedbackteam collaborationproblem-solvingadaptability