Bill Review Associate III

1 week ago

Mandaluyong City, National Capital Region, Philippines MedRisk LLC Full time $40,000 - $80,000 per year

Bill Review Services Associate

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.

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