Medical Bill Reviewer

Medical Bill Reviewer

Our Story

Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

What’s in Store

We're on the lookout for a Medical Bill Reviewer to join our growing team! As a Medical Bill Reviewer, you will review Workers’ Compensation provider medical bills via the system for cost containment purposes. You will analyze, review and recommend payment to medical providers, hospitals, ancillary medical providers, rehabilitation services and pharmacies and significantly reduce costs to clients. Additional responsibilities include:

• Process Workers’ Compensation medical bills for payment according to specific state Workers' Compensation fee schedule and beyond via system entry and software
• Accurate data entry and adjudication of provider bills in the Corrus computer system according to state Workers’ Compensation Fee Schedule rules, with satisfactory volume and error ratio.
• Analyze, review and recommend payment to medical providers based upon statutory rules or guidelines and/or provider reimbursement contract amounts to achieve maximum cost savings, to the level appropriate in terms of:

1. Medical necessity
2. Treatment actually rendered
3. Adjuster authorizations
4. Usual or reasonable and customary charges
5. Utilization practices
6. Applicable fee schedules
7. Contracted agreements
8. DRG validation

• Utilize Fee Schedules, online document, client instructions and other training material to properly review medical bills
• Research usual and customary/Fee Schedule applications as appropriate
• Ensure timely payments to providers meet statutory regulations on the type and amount of reimbursement and significantly reduce costs
• Handling of provider and customer phone calls
• Training on an on-going basis to increase knowledge with State Fee Schedule, medical terminology, use of reference materials, e.g. CPT, ICD-10, HCPCS
• Perform other duties as requested

This role is a full-time, remote position.

Your Expertise, Skills, and Abilities

• Minimum of one-year medical terminology/medical office experience, including working with medical providers and professionals
• Typing 60+ wpm/10-key by touch; heavy numerical data entry with high ratio of accuracy
• Produce 120 bills per day with an accuracy rate of 95%+
• Previous experience in specific state’s Workers’ Compensation Fee Schedule, CPT, ICD-10, HCPCS coding
• Familiarity with provisions and contents of other state WC programs, particularly in FL, GA, CA, SC, NC, VA, AL and TN
• Proficient with the use of Microsoft Office Suite
• Ability to effectively operate a personal computer and related claims and business software
• Other skills and abilities:

1. Proactive, independent, and takes initiative with consistent follow through
2. Superb communication skills, verbal and written, conducted in a timely manner
3. Superior time management skills with capability of working with and meeting deadlines
4. Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment
5. Excellent team player with interpersonal skills
6. High level attention to detail and problem-solving skills
7. Capable of working collaboratively and independently with minimal supervision
8. Exhibit discretion with sensitive and confidential information

Benefits

At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:

• Medical, dental, and vision plans to ensure your health and that of your family
• A 401k plan with employer matching to help you build a secure financial future
• Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment
• Paid holidays.
• Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones

Diversity and Inclusion

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.