What are the responsibilities and job description for the Medical Bill Reviewer position at Davies Group?
Medical Bill Reviewer
Our Story
Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America , we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.
What’s in Store
We're on the lookout for a Medical Bill Reviewer to join our growing team! As a Medical Bill Reviewer, you will review Workers’ Compensation provider medical bills via the system for cost containment purposes. You will analyze, review and recommend payment to medical providers, hospitals, ancillary medical providers, rehabilitation services and pharmacies and significantly reduce costs to clients. Additional responsibilities include :
- Process Workers’ Compensation medical bills for payment according to specific state Workers' Compensation fee schedule and beyond via system entry and software
- Accurate data entry and adjudication of provider bills in the Corrus computer system according to state Workers’ Compensation Fee Schedule rules, with satisfactory volume and error ratio.
- Analyze, review and recommend payment to medical providers based upon statutory rules or guidelines and / or provider reimbursement contract amounts to achieve maximum cost savings, to the level appropriate in terms of :
- Medical necessity
- Treatment actually rendered
- Adjuster authorizations
- Usual or reasonable and customary charges
- Utilization practices
- Applicable fee schedules
- Contracted agreements
- DRG validation
- Utilize Fee Schedules, online document, client instructions and other training material to properly review medical bills
- Research usual and customary / Fee Schedule applications as appropriate
- Ensure timely payments to providers meet statutory regulations on the type and amount of reimbursement and significantly reduce costs
- Handling of provider and customer phone calls
- Training on an on-going basis to increase knowledge with State Fee Schedule, medical terminology, use of reference materials, e.g. CPT, ICD-10, HCPCS
- Perform other duties as requested
This role is a full-time, remote position with a 30 hour per week schedule of Saturday and Sunday from 7 PM ET-7 AM ET (24 working hours 6 hours of "on call" paid time).
Your Expertise, Skills, and Abilities
Benefits
At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes :
Diversity and Inclusion
Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.
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