Job Description

MUST HAVE CPC CERTIFICATION

Position Summary:

The medical bill review/cost containment supervisor ensures that the Company’s medical bill review staff meets daily production and accuracy quotas in analyzing and processing workers’ compensation and auto medical invoices in accordance with prevailing fee schedule or UCR guidelines.

Duties include:

• Oversees the daily operations of the Company’s medical bill review/cost containment department

Supervise all medical bill review/cost containment staff

• Ensures the efficient repricing and direction of incoming bills during analysis and bill payments based on applicable repricing rules/edits and prevailing fee schedule or UCR guidelines.

• Responsible for the accurate and efficient coding of medical bills into the Company’s repricing database.

• Reviews medical fee and other supporting documentation for appropriate use of CPT and ICD-10 codes/fee schedules.

• Reviews medical fee data, supporting data, and other documentation or resources (including duplication and prior authorization verification) to ensure appropriate use of CPT and ICD-10 codes and correct reimbursement of billed services.

• Resolves bills/issues flagged by medical bill review staff

• Efficiently reprices and directs incoming bills by analyzing bill payments based on prevailing fee schedule and other rule edits/guidelines.

• Accurately and efficiently codes medical bills into the Company’s repricing database

Required skills/abilities include:

• Demonstrated experience supervisory experience in workers’ compensation and auto medical bill review/cost containment, bill repricing and/or bill coding.

• Must have bill repricing/coding experience of workers’ compensation and auto injury invoices in New York jurisdiction.

• Ability to speak and write clearly and concisely, while applying strong interpersonal communication skills

• Ability to adapt to changes in duties and assignments in the work environment.

• Ability to organize, prioritize and coordinate multiple tasks

• Ability to produce work in high quantity and quality

• Proficiency in Microsoft Office applications; Word, Outlook (Excel a plus) and standard office equipment, including: computers, fax machines, copiers, printers, telephone, calculators, etc.

Preferred qualifications:

• RN licensure and minimum two (2) years clinical/practice experience.

Mental/Physical Requirements:

This position involves sitting and working with a keyboard and monitor for the entire workday.

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