Medical Bill Review Appeals Specialist

Summary of Functions:

The Appeal Coordinator and Hearing Representative is responsible for addressing appeals received from Health Care Providers or clients, ensuring adherence to State guidelines. Defend all State Care bill review decisions at the Workers Compensation Appeals Board. Possess a working knowledge on the billing and reconsideration process for Workers Compensation.
Essential Duties and Responsibilities:
• Review medical claims for initial billing, billing follow-up or preliminary determination whether denial can be overturned with a reconsideration.
• Inform Manager of trends noticed when working denials or appeals
• Respond to provider inquiries relating to bill review analysis.
• Analyzes issues using problem solving methodology skills to determine root cause.

Communicate and implement solutions.
• Resolves issues successfully in a proactive and timely manner. Communicates outcome to client or provider.
• Refers to reference library of fee schedules, CPT, ICD, HCPCS and other industry publications to research and support findings.
• Analyzes individual case information by reviewing file and through discussion with clients

Qualifications:
• High School Diploma or GED required; Associate Degree preferred
• California Certification for Medical Bill Coding preferred
• At least 5 years reviewing medical bills and coding in Workers Compensation
• Knowledge of CMS 1500, CPT, ICD, and HCPCS
• Strong detailed analytical skills
• Computer literate, Intermediate MS Excel and Word
• Proficiency with 10-key pad at 9000+kph
• Strong written and verbal communication skills

Benefits:
• 401(k) with employer matching
• Dental insurance
• Health insurance
• HSA and FSA
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Pay:
$55,000.00 - $73,000.00 per year

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