Bill Review Associate III

7 hours ago

Mandaluyong City, National Capital Region, Philippines MedRisk LLC Full time ₱900,000 - ₱1,200,000 per year

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 skillset 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

9PM - 6AM Monday to Friday

Graveyard Shift

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