Job Description

Purpose:
In this role, you'll manage the manual processes involved in applying PPO guidelines to medical bills, ensuring accuracy and timeliness.

Key Responsibilities:

Identify whether a provider is participating or non-participating when the automated system is unable to determine this.
Apply PPO guidelines accurately to bills where automated processes fall short.
Communicate with clients and internal Bill Review staff via email or phone to:
Request bill images or documentation needed to apply a PPO discount correctly.
Address and resolve keying errors or discrepancies to ensure proper PPO discount application.
Interact with the PPO Application team through email, phone, or in person to address questions and concerns about specific bills or general policies.
Use relevant software and documents to calculate contracted rates, including AWP, Medicare, or state and federal-mandated fee schedules.
Support the Senior PPO Application Specialist with the quality assurance (QA) process as needed.
Education:
High School Diploma or equivalent required.

Required Experience and Skills:

Experience with medical billing processes, including familiarity with CPT Codes, Revenue Codes, Bill Types, ICD-9/ICD-10 Codes, State Fee Schedules, UCR, and PPO.
Proficiency with Windows-based software and applications.
Accurate typing skills.
Ability to review documentation and make informed decisions based on department policies and procedures.
Strong teamwork and collaboration skills.
Self-motivated and proactive attitude.
Equal Employment Opportunity Statement:
We are committed to providing equal employment opportunities to all employees and applicants. We prohibit discrimination and harassment of any type, regardless of 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 covers all aspects of employment, including recruitment, hiring, placement, promotion, termination, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour

Job Tags

Hourly pay, Full time, Local area,

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