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Medical Bill Processor

CLAIM YOUR FUTURE AS A GREAT PERFORMER!Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."

PRIMARY PURPOSE:
To review hospital and professional medical bills from provider including complex hospital, surgical, high level evaluation and management codes, and/or technical bills.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Processes bills in accordance with multi state schedules, rules, regulations and guidelines.
Applies PPO contract discounts to bills.
Reviews operative reports to determine if surgery services were appropriately billed.
Reviews complex medical, legal and consult services.
Contacts client or facility to obtain additional or missing information.
Handles provider appeals where appropriate to fee schedule and contractual disputes.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.

QUALIFICATIONS
Education & Licensing
High School diploma or GED required.

Experience
Two (2) years workers' compensation and/or bill review experience required; provider appeals experience required. Experience in PPO re-pricing, surgery review, by report and RNE review preferred and two (2) years experience with complex medical, legal and consult review preferred.

Skills & Knowledge
Knowledge of re-pricing rules and guidelines
Knowledge of medical terminology, anatomy and surgical terms
Knowledge of CPT/ICD9
PC literate, including Microsoft Office products
High level of accuracy and attention to detail
Ability to multi-task and function in high volume area
Ability to handle deadlines and proactively problem solve
Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick CMS is an Equal Opportunity Employer
and a
Drug-Free Workplace

How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://sedgwickcms.contacthr.com/21012224

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Published on Aug 24, 2011
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