General Purpose
As the Bill Review Supervisor, you will oversee a team of medical bill review processors and foster a high-performance culture through development, training, and coaching. This role requires expertise in medical billing, coding, and claims and keen attention to detail to identify errors and discrepancies. The Supervisor is also responsible for evaluating daily workflows and providing actionable feedback to the VP of Claims and Operations to enhance overall efficiency. You will report to the VP of Claims.
Duties & Responsibilities
- Supervise and evaluate personnel on your team.
- Accurately and appropriately analyze complex medical bills (CEA, Stop Loss, BRAID, Disputes) and make payment recommendations based on claim history, medical notes, and statutory regulations, including state laws and fee schedules, coding guidelines, client guidelines, and company policies and procedures.
- Oversee the team to ensure disputes/reconsiderations are executed effectively according to client protocols, compliance deadlines and state regulations.
- Communication with medical providers and state agencies will be required for specific medical bills.
- Research, compile, and gather medical provider data in preparation for scheduled hearings. Work closely with our legal team to provide specific exhibits for MO and other states.
- Participate, train, and help lead the quality assurance (QA) process, BR processors, and workflow.
- Respond to issues and drive problem resolution in a quick turnaround time.
- Participate in ongoing training to enhance job skills and knowledge.
- Maintain monthly statistical information regarding employee performance and perform annual reviews.
- Continuous working knowledge of WellRithms’ proprietary software Harmony, Melody, and other BR-related systems.
- Demonstrate positive behavior and lead by example to improve the work environment.
- Support and assist all levels of the organization.
- Work closely with implementation and operational teams regarding specific client workflows.
Qualifications
- Bachelor’s degree preferred but not required.
- 5+ years of experience in complex Workers’ Compensation Bill Review with customer service exposure.
- Knowledge of medical terminology, CPT, DRG, Revenue, HCPC, ICD9/10 codes, Workers Compensation and Group Health regulations
- Ability to read, analyze, and interpret technical procedures, medical reports, state laws, and fee schedules.
- CPC (Certified Professional Coding) coursework or certification is a big plus.
- Experience supervising staff members.
- Demonstrate the ability to manage people in a fast-paced environment.
- Good Written and Oral Communication Skills
- Good interpersonal and organizational skills
- Strong oral, written, and interpersonal skills.
Classification: Salary Exempt
Status: Full-time Regular
Apply Now