Manager, Bill Review
- Dallas, TX
- Permanent
- Full-time
- Develop, recommend and implements short and long term objectives consistent with company business goals, guidelines and program
- Effectively plan responsibilities and manage activities, utilizing staff resources to meet department goals in accordance with established business plans.
- Monitor and analyze significant workers compensation fee schedule changes in service territories that may impact claim operations; communicates conclusions and recommendations to the appropriate parties
- Interprets hospital review guidelines for both inpatient and outpatient claims.
- Promote effective communication among and between work groups, and between management and employees. Collaborate with claim offices and vendor's.
- Ensure quality management of medical bill vendor in accordance with regulatory changes.
- Provide coaching and training of field office leadership and claims adjusters.
- Experience developing training material for workers compensation bill review.
- Ability to identify billing trends
- Responsible for preparing reports for management, by collecting, analyzing, and summarizing claim information. Keeps apprised of changes in the law and court procedures affecting claims in jurisdictions supervised.
- Establishes the appropriateness of a final reimbursement outcome by making the distinction between and knowing when to apply either Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction.
- Assessing payments against regulatory or administrative charges, coding, and billing errors.
- Assisting in the development and implementation of new audit/review methodologies to identify overpayments and underpayments to providers.
- Developing, maintaining, and ensuring adherence to multiple project schedules.
- Participating in planning, daily meetings
- Respond daily to billing related questions
- Provide professional customer service to our clients in the field
- Strong communication, including writing, speaking and active listening
- Bachelor's Degree or equivalent experience
- 2+ years of claims experience in positions of increasing responsibility
- Knowledge of CPT, ICD-9, HCPC coding methodology
- Extensive knowledge of claims regulations and applicable laws with specific knowledge of Workers' Compensation within servicing states
- Extensive knowledge of workers compensation fee schedule guidelines, medical billing, and medical terminology
- Experience in bill processing platforms
- Excellent verbal and written communication skills
- 2+ years of Medical Bill Review specific experience
- Certified Professional Coder
- Previous experience in a leadership position with proven record of goal achievement and superior customer service
- Experience with State and external accreditation managed care audits and with writing and implementing program level policy and procedures