Medical Billing Adjudicator

Chesapeake Employers' Insurance Company
Towson, MD
Nov 18, 2022
Nov 30, 2022
Full Time
POSITION SUMMARY:Processes medical, specialty vendor bills and reimbursements to claimants in following the the WorkersA$ cents A cents ' not A cents " cents Compensation Commission Fee Guide or Chesapeake Employers contracted pricing in accordance with established Chesapeake policies and procedures. Serves as a resource for training and assists team leads in daily operational activities./_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_DUTIES AND RESPONSIBILITIES:- Performs data entry of bills submitted for processing by accurately recording the required information into the correct fields in WCIS.- Processes physicians bills.- Determines if charges are related to accepted claim through knowledge of medical diagnostic coding and review of accepted body parts. Denies unrelated bills or charges.- Processes bills submitted for medical treatment in accordance with established Chesapeake policies and the WC Fee Guide. 1- Reviews the claims notepad for authorizations and notes regarding billing issues as indicated. Uses judgement in referring bills to adjusters if further investigation is warranted.- Accepts or denies charges while selecting appropriate reason codes.- Responds to inquiries from claimants, medical providers and company personnel regarding the payment, denial of payment or clarification required for completion of processing.- Meets departmental guidelines for productivity and accuracy of processing of medical bills.- Attends web-based training to develop in-depth knowledge in specific specialty areas to maintain industry standard practices.- Assists coders in resolving consideration requests as needed- Assists with quality audits/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_SKILLS, EDUCATION AND EXPERIENCE:- A High School Diploma or equivalent is required.- 2-3 yearsA$ cents A cents ' not A cents " cents experience in bill processing.- PC skills including Excel familiarity.- Excellent communication skills, both verbal and written.- ICD-9, ICD-10 and CPT coding knowledge.- Medical terminology familiarity- Bilingual skills preferred.- CPC preferred. CPC will be required within 3 years of employment./_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_POSITIONAL COMPETENCIES:- Bias for Action- Knowledge Sharing- Deliver Results- Service and Sales Excellence- Personal Leadership- Teamwork and Communication/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_PHYSICAL DEMANDS:While performing the duties of this job, the employee is regularly required to sit, use hands to finger, handle or feel objects, tools or controls; reach with hands and arms. The employee is occasionally required to stand, walk, stoop, kneel, crouch or crawl. The employee may occasionally lift up to 30 pounds. Specific vision abilities are required, which include close vision, peripheral vision and the ability to adjust focus./_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_/_WORK ENVIRONMENT:Office Environment. The noise level is usually moderate.Job Type: Full-timePay: $20.27 - $23.85 per hourBenefits:* 401(k)* 401(k) matching* Dental insurance* Disability insurance* Employee assistance program* Health insurance* Life insurance* Paid time off* Tuition reimbursement* Vision insuranceSchedule:* 8 hour shift* Day shift* Monday to FridaySupplemental pay types:* Bonus payWork Location: One location