Bill Review Associate III

Description

Who we are… 

CompIQ Solutions is a software and full-service provider focusing on the property and casualty medical bill review market. We provide an end-to-end solution for our clients leveraging our proprietary technology and software platforms in the delivery of our solutions and services. We focus our efforts on our three key stakeholders, in this order: 1) Clients; 2) Colleagues; 3) Company. 

 Duties and Responsibilities 

• Processes bills in accordance with multi-state schedules, rules, regulations and guidelines.
• Reviews medical and consult services. 
• Knowledge of multiple state jurisdictional regulations and rules
• Able to email the client, adjuster or provider to obtain additional or missing information.
• Handles provider appeals where appropriate to fee schedule and contractual disputes.
• Must be able to analyze and review high-level office visits, reports, and record reviews. This often requires an in-depth review and independent judgment.
• Able to interpret hospital review guidelines for both inpatient and outpatient claims
• Able to process and review bills such as med-legal, Appeal, Consultation, Surgery, Hospital bills, Technical, and other complex bill.
• Perform specialty bill review functions for PPO, liability and no- fee schedule claims
• Continued study of all bill review methodologies including Usual & Customary, fee schedules, PPO discounts, etc.

Requirements

Qualifications: 

• Someone who has experience in a Medical billing review or healthcare background.
• Able to work at any shift schedule.
• Ability to work in a high production   environment while meeting productivity and quality standards.
• Has strong knowledge in Microsoft Word and Excel
• Familiarity with different types if bill such HFCA, Ebills, Invoice, Dental and Hospital.
• Familiarity with Medicare payment methodologies including the use of the National Correct Coding Initiative   (NCCI) payment policies.