医疗账单协调员
Medical Bill Coordinator
加入Sedgwick，你将参与真正有意义的工作。我们的33,000名同事每天为全球面临意外的人们提供帮助。我们邀请你与我们共同成长，体验我们的关怀文化，并享受工作与生活的平衡。在这里，你所能实现的没有界限。
Newsweek 将 Sedgwick 评为美国最佳 workplaces 国家顶级公司
被认证为 Great Place to Work®
财富最佳金融服务与保险工作场所
医疗账单协调员
主要职责：审查来自供应商的医院和专业医疗账单，包括复杂的医院账单、手术账单、高级评估和管理代码，以及/或技术账单。
核心职责和任务
- 按照多州的计划、规则、法规和指南处理账单。
- 对账单应用 PPO 合同折扣。
- 审查手术报告，确定手术服务是否正确计费。
- 审查复杂的医疗、法律和咨询服务。
- 联系客户或机构获取额外或缺失的信息。
- 在适当的情况下处理供应商申诉，涉及费用表和合同纠纷。
- 向管理层沟通内部问题。
- 协助账单审核团队主管进行流程管理，指导和辅导员工。
- 协助新员工的流程、程序和系统培训。
其他职责和任务
- 执行分配的其他任务。
- 支持组织的质量项目。
- 按需出差。
资格要求
教育与执照
需要高中文凭或 GED。
经验
需要两年工伤赔偿和/或账单审核经验，或教育和经验的等效组合，包括供应商申诉经验。优先考虑 PPO 重新定价、手术审核、按报告和 RNE 审核经验。优先考虑两年复杂医疗、法律和咨询审核经验。
技能与知识
- 熟悉重新定价规则和指南
- 熟悉医学术语、解剖学和外科术语
- 熟悉多州管辖法规和规则
- 熟悉费用表、规则和 U&C 指南
- 熟悉 CPT/ICD9
- 熟练使用电脑，包括 Microsoft Office 产品
- 具备领导力和激励他人的能力
- 强大的口头和书面沟通能力
- 强大的人际交往能力
- 高度的准确性和细节关注度
查看英文原文
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Medical Bill Coordinator
PRIMARY PURPOSE: To review hospital and professional medical bills from provider including complex hospital, surgical, high level evaluation and management codes, and/or technical bills.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Processes bills in accordance with multi state schedules, rules, regulations, and guidelines.
- Applies PPO contract discounts to bills.
- Reviews operative reports to determine if surgery services were appropriately billed.
- Reviews complex medical, legal and consult services.
- Contacts client or facility to obtain additional or missing information.
- Handles provider appeals where appropriate to fee schedule and contractual disputes.
- Communicates internal issues to management.
- Assists bill review team lead with workflow management, coaching and mentoring of staff.
- Assists with process, procedure and system training for new staff.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travel as required.
QUALIFICATIONS
Education & Licensing
High School diploma or GED required.
Experience
Two (2) years workers' compensation and/or bill review experience or equivalent combination of education and experience required to include provider appeals experience. PPO re-pricing, surgery review, by report and RNE review preferred. Two (2) years of experience with complex medical, legal, and consult review preferred.
Skills & Knowledge
- Knowledge of re-pricing rules and guidelines
- Knowledge of medical terminology, anatomy and surgical terms
- Knowledge of multiple state jurisdictional regulations and rules
- Knowledge of Fee Schedules, Rules, and U&C Guidelines
- Knowledge of CPT/ICD9
- PC literate, including Microsoft Office products
- Leadership skills and ability to motivate others
- Strong verbal and written communication skills
- Strong interpersonal skills
- High level of accuracy and attention to detail
- Ability to multi-task and function in high volume area
- Ability to handle deadlines and proactively problem solve
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $.19.00. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
Originally posted on Himalayas