Medical Billing Review Technical Specialist

Medical Bill Review Technical Specialist

SFM -- The Work Comp Experts. Work Somewhere You Love.

 About SFM

Since 1983, SFM’s mission has been to be the workers’ compensation partner of choice for agents, employers, and their workers. While we’ve expanded to over 20,000 customers in the Midwest, and have grown our offerings to include vocational rehab, safe patient handling, loss prevention, medical services (and more!), our focus continues to be unrivaled customer service, injury prevention, and results.

The role

Are you ready to work for a company that values their employees?  If so, SFM is seeking a Bill Review Technical Specialist who will provide support to team members in application of bill review management policies, medical coding,  practices and procedures.  You will audit and support the bill review team in accordance with state Workers’ Compensation Fee Schedules and perform regular internal audits to ensure best practices and quality standards are met.   This position performs complex bill reviews to include surgery, inpatient and outpatient services, and is responsible for appeals, medical disputes, over payments and technical lead/audit/liaison duties as well internal training needs. SFM offers a robust benefit package.

 Responsibilities 

1. Identify improvement opportunities and keep abreast of mandated rules, procedures and forms which includes development of expertise in business processes and bill review handling in core states and communicate modifications and recommendations to Medical Services Manager.
2. Act as primary liaison to bill review software vendor and update all custom SFM business rules added to the vendor bill review system.
3. Proactively meet with various business teams to monitor performance of bill review team and understand workflow/service issues.
4. Evaluates PPO networks and other medical cost savings tools and services and makes recommendations.
5. Assist the Medical Services Manager by keeping apprised of emerging trends and perform bill reviews.
6. Participate in industry associations and conferences related to bill review functions.
7. Researches, analyzes and updates ICD, CPT and DRGs as needed.
8. Create reports as needed through Cognos or software vendor reporting.
9. Performs bill payment duties up to 25% of the time and provide back-up assistance to team members.
10. Directs the day-to-day operations of the bill review team, prioritizing tasks and work assignments as needed based on incoming work, phone inquiries and operational needs of the team, ensuring all bill review service standards are met or exceeded. Assigns and adjusts responsibilities as needed.
11. Handles complex and escalated bill review issues, complicated requests, complaints and unique service issues.
12. Identify, develop and implement business solutions to business needs and special projects.

      We’re looking for: 

• Bachelor’s degree or equivalent experience in related field such as technical training in a medical (coding) or insurance environment.
• Five years’ experience in medical, bill review or related field; with experience working in workers’ compensation insurance preferred.
• Accredited Records Technologists (ART), Certified Professional Coder (CPC), Licensed Practical Nurse (LPN) or other medical-related certification or designation strongly preferred.
• Broad bill review, medical provider and medical procedural/terminology knowledge with a specialization in applicable state Workers’ Compensation Fee Schedules.
• Analytical skills relating to business interpretation of medical documents, including CPT, ICD-9/ICD-10 and procedure codes.
• Exceptional communication skills, both written and oral.
• Strong organizational skills and the ability to manage multiple projects and work with minimal direction and be detail oriented.
• Ability to mentor and assist in employee development.
• Strong computer skills related to bill review software, word processing and spreadsheets.
• Proficient 10-key skills.
• Ability to apply primary mathematical functions.
• Strong negotiation skills.
• Positive team building skills.
• Strong presentation skills and the ability to educate employees regarding best practices, policies and procedures.
• Ability to inspire, coach and educate on customer service standards and best practices.

 Physical Requirements: 

Work takes place in a paperless environment within an office, using a standard office equipment such as computers, phones, photocopies, which requires being stationary for extended periods of time.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions. 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions