Medical Bill Reviewer - Remote Job at Get It Recruit - Healthcare, Trenton, NJ

M2NMMTBOUkNLNWJ6dk9IakV5NVdCYnloK3c9PQ==
  • Get It Recruit - Healthcare
  • Trenton, NJ

Job Description

Purpose:
As a PPO Application Specialist, you will be responsible for efficiently and accurately applying PPO guidelines to medical bills, ensuring timely and precise processing.

Essential Job Functions:

Provider Identification: Determine if providers are participating or non-participating when the automated system cannot make that determination.
Guideline Application: Apply PPO guidelines to bills where a participation match has been made, particularly when the automated re-pricing process is unable to do so.
Communication:
With Clients and Internal Teams: Request bill images or necessary documentation, address keying errors or discrepancies, and ensure proper PPO discount application.
With the PPO Application Team: Discuss specific bills or general policies and procedures to resolve questions and concerns.
Rate Calculation: Use appropriate software and documents to calculate contracted rates, including AWP, Medicare, or state and federal-mandated fee schedules.
Quality Assurance: Assist the Senior PPO Application Specialist with the QA process as needed.
Education:

High School Diploma required.
Required Experience and Skills:

Medical Bill Processes: Familiarity with CPT Codes, Revenue Codes, Bill Types, ICD-9 and/or ICD-10 Codes, State Fee Schedules, UCR, and PPO.
Technical Skills: Experience with Windows-based software/applications.
Attention to Detail: Ability to type accurately and review documentation to make informed decisions based on department policies and procedures.
Teamwork: Desire to collaborate effectively with others.
Self-Motivation: Drive to be a proactive self-starter.
Equal Employment Opportunity Statement:
We are committed to providing equal employment opportunities to all employees and applicants. We prohibit discrimination and harassment of any kind, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Join our team and play a crucial role in ensuring the accurate and timely processing of medical bills in accordance with PPO guidelines. If you have the required skills and are passionate about making a difference, we would love to hear from you!
Employment Type: Full-Time
Salary: $ 20.00 Per Hour

Job Tags

Hourly pay, Full time, Local area,

Similar Jobs

City of Mesquite, TX

Director of Public Works Job at City of Mesquite, TX

 ...Job Type: Full-time Job Number: 1302610 Department: Public Works Administration Opening Date: 08/17/2024 Closing Date: 9...  ...Assistant City Manager. Responsible for supervision of the Assistant Director of Public Works, City Engineer and five divisional managers.... 

Smile Keepers

Expanded Practice Dental Hygienist Job at Smile Keepers

 ...Capitol Dental is searching for a full-time Expanded Practice Hygienist. Are you looking for a flexible schedule and an environment that will support and encourage your growth as a provider? Are you looking for independence and the chance to serve your community at... 

ECI -Engineers Construction, Inc.

Directional Drilling Foreman Job at ECI -Engineers Construction, Inc.

 ...Job Description Williston, VT based Engineers Construction, Inc. (ECI) has an opening in our Trenchless Division for a Directional Drilling Foreman with 5-10+ years of experience. A working knowledge of heavy equipment is required, as is experience working with... 

Army National Guard

12R Interior Electrician Job at Army National Guard

As overseers of electricity, Interior Electricians are valuable to the operations of the Army National Guard. Theyre the Soldiers who light the way for their crews by installing and repairing wire systems in offices, repair shops, airplane hangars, and other buildings.... 

Keeper Security, Inc.

Senior Copywriter Job at Keeper Security, Inc.

 ...Job Description Job Description Keeper Security is hiring a passionate and detail-oriented Senior Copywriter to join our creative team. This is a 100% remote position with an opportunity to work a hybrid schedule for candidates based in the Chicago, IL metro area...