Resource consultant

Consultant-Med Resources

US-TX-Richardson

Job ID : 2024-36383

Type : Regular Full Time

of Openings : 2

Category : Claims and Investigation

Richardson, TX

Overview

Build your career at one of the top companies for professional growth in the U.S.! Khakis optional...

At State Farm we invest in our employees by providing a competitive Total Rewards package :

You are also eligible for :

• An annual bonus based on individual and enterprise performance
• Annual merit increases
• 401(k) contribution
• Paid Time Off (PTO), plus : 5 days of Life Leave to take care of yourself and your family, Paid Volunteer Time, and an Annual Celebration Day to celebrate what's important to you!
• Industry leading Tuition Assistance Programs
• Wellnessand mental health programs
• Discounts from hundreds of retailers through our Perks at Work program

And more!

This is a hybrid position which allows you to spend some of your time working from home as well as some time working collaboratively in-office.

During the job training period you may have a higher percentage of time spent in-office to support your learning experience.

Being good neighbors - helping people, investing in our communities, and making the world a better place - is who we are at State Farm.

It is at the core of how we operate and the reason for our success. Come join a #1 team and do some good!

Responsibilities

Utilizes medical background to serve as a resource to claim handlers with understanding medical treatment, diagnoses, mechanism of injury, billing / coding information, etc.

presented in the claim and the automated medical bill review application.

Responsibilities include :

• Works directly with claim handlers and / or leadership to answer questions about injuries, medical billing and coding via phone or system generated tasks
• Assists claim handlers by providing assistance with understanding medical information presented in the claim file such as medical terminology, information or medical records to request, standard of care and scope of practice, medical necessity, diagnostic equipment / testing, information to consider on diagnosed injuries / medical treatment, etc.
• Assists with the design of training programs and presents approved training to P&C Claims regarding the understanding and analysis of injuries, medical billing / coding topics and automated bill review applications
• Conducts comprehensive and analytical reviews of medical records and billing / coding at the request of claim handlers or by system generated task assignment
• Works queues within the automated medical bill review application(s) and claims system
• Provides assistance to claim management and claim handlers regarding the Independent Medical Exam (IME) and Utilization Review (UR) processes
• Identifies and provides training to claim handlers and claim management for first and third party injury claim handling
• Reviews training and information on injury topics and assists with updates and development of claims training material
• Researches information about medical diagnostic tools, injuries, treatment protocols, billing and coding standards, and state fee schedules
• Monitors and identifies jurisdictional bill trends and national medical industry billing standards
• Monitors, identifies and reports automated medical bill review application and / or setting issues
• Reviews release notes on automated medical bill review application(s) in anticipation of changes affecting the bill review software
• Validates new and updated automated medical bill review application functionality

Qualifications

Required :

• Strong written and verbal communication skills
• Strong critical thinking and decision-making skills
• Ability to multi-task across technical platforms
• Accountability
• Resourcefulness

Qualifications / Items of Note :

• Typically has medical experience as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Chiropractor (DC), Physical Therapist (PT) or Physician (MD or DO) and / or possesses substantial medical education and experience
• Completion of applicable training or continuing education courses as needed
• Continuous study of developments in the field of injuries, treatment and prognosis of injuries, mechanism of injury, medical / vocational rehabilitation, and medical billing and coding is expected
• This is not a claim handling role, nor is it a practicing medical professional.
• May be required to work additional hours, non-standard hours, including varying work shifts, nights, weekends and holidays, based on workload and as the operation dictates
• Job may require travel overnight via commercial transportation or driving motor vehicles to any office locations where the Company does business, or other locations to conduct / attend training, conferences, meetings, and / or seminars

Please see job description

PI238485444

Last updated : 2024-03-26

Salary : $37 - $47