Bill Review Services Associate III

2 weeks ago

Zamboanga City, Zamboanga Peninsula, Philippines Conduent Full time

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Job Track Description:

  • Performs tasks based on established procedures.
  • Uses data organizing and coordination skills to perform business support or technical work.
  • Requires vocational training, certifications, licensures, or equivalent experience.

General Profile

  • Proficiency within a range of analytical or operational processes.
  • Completes atypical assignments.
  • Works within established procedures and practices.
  • May establish the appropriate approach for new assignments.
  • Acts as a resource for colleagues.
  • Completes work with limited supervision.

Functional Knowledge

  • Has developed skills in a range of processes, procedures, and systems.

Business Expertise

  • Understanding of how teams integrate and work best together to support the achievement of company goals.

Impact

  • Impacts a team, by example, through the quality service and information provided.
  • Uses discretion to change work procedures and practices.

Leadership

  • May provide guidance and support to junior team members.

Problem Solving

  • Provides solutions to atypical problems based on existing precedents or procedures.

Interpersonal Skills

  • Exchanges information and ideas effectively.

Responsibility Statements

  • Reviews specialized Medical Bills including hospital, surgery, and high-level physician bills.
  • Establishes the appropriateness of a final reimbursement outcome by making the distinction between and knowing when to apply either Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction.
  • Communicates and upholds the basis for the methodology used to accomplish the reduction of charges.
  • Analyzes and reviews high-level office visits, reports, and record reviews.
  • Interprets hospital review guidelines for both inpatient and outpatient claims.
  • Conducts test studies for the compliance team, requiring high-quality results and strict deadlines.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.

People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form. You may also click here to access Conduent's ADAAA Accommodation Policy.

At Conduent we value the health and safety of our associates, their families and our community. For US applicants while we DO NOT require vaccination for most of our jobs, we DO require that you provide us with your vaccination status, where legally permissible. Providing this information is a requirement of your employment at Conduent.

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