Bill Review Associate I
5 hours ago
The Bill Review Associate I is responsible for analyzing and auditing medical billing data to ensure accuracy, proper coding, and compliance with reimbursement policies. The role supports cost containment and quality improvement in healthcare services through effective bill review and interpretation of medical documentation.
Key Responsibilities:
- Audit and evaluate payment determinations, reconsiderations, and re-reviews of medical billing data.
- Analyze lower-level technical bills including high-level office visits, medical reports, and records to determine accuracy.
- Review medical reports, diagnostic results, and treatment plans to validate proper reimbursement or recommend adjustments.
- Assist in assigning procedure codes, including complex and comprehensive exam codes.
- Maintain a reference library of internal and external reimbursement policies and coding guidelines.
- Conduct test studies for the Compliance Team, meeting aggressive deadlines while ensuring accuracy and completeness.
- Ensure compliance with all company policies, procedures, and applicable regulations.
- Perform other related duties as assigned.
Qualifications:
- Bachelor's degree in a healthcare or business-related field, or equivalent experience
- Minimum of 1–2 years of experience in medical billing or healthcare claims review, with direct experience in Workers' Compensation bill review processing required.
- Certification in medical coding (CPC, CCS, or equivalent) preferred.
- Strong knowledge of Workers' Compensation billing processes, rules, and fee schedules.
- Proficient in applying CPT, ICD, and HCPCS coding standards.
- Excellent attention to detail and analytical skills.
- Familiarity with medical billing software and Microsoft Office tools.
- Strong written and verbal communication skills.
- Ability to manage workload independently within established procedures.
Onsite training then will transition to hybrid setup in Mandaluyong City (1 day onsite, 4 days remote)
Job Types: Full-time, Permanent
Benefits:
- Health insurance
- Opportunities for promotion
- Paid training
- Promotion to permanent employee
Work Location: In person
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