Senior Bill Review Services Analyst

Dublin, Ohio
Not Specified
Mar 14, 2018
May 13, 2018
Job Type
Not Specified
Career Level
Not Specified

York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.

Job Description

This position identifies an individual who has strong technical bill review skills. They have broader and more extensive expanded experience and knowledge in this area. This position will be responsible for reviewing and re-pricing workers' compensation bills including bills considered being to be rated at a higher degree of difficulty.

  • Responsible for reviewing medical bills - in accordance to the Official Medical Fee Schedule. Must apply Utilization Review (UR) decisions and MPN information to the workers' compensation medical bills. Must be able to review bills for facility charges, surgical bills, ambulance services and med-legal reports; Must take an active role in reviewing appeals/reconsiderations as well as "Review Only" bills.
  • Responsible for helping with quality/batch prep reports to ensure accuracy of reviews before they are returned to the file. Must be able to help identify billing issues and be able to help with identifying strategies to address the issues.
  • Work in close coordination with the Claims Examiner and Utilization Review team for the accurate completion of all bill review actions.
  • Complete a minimum standard of 200 reviews per day. Claim number and provider information must be checked for accuracy. Application of state guidelines, PPO's and UR decisions to the medical bills.
  • Act as a resource for the WellComp Service Center Team.
  • Other duties as assigned

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