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