At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. Thats why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.

Job Description

• Responsible for reviewing medical bills in accordance to the fee schedule, U&C and/or internal processing guidelines and for data accuracy
• Applies Utilization Review (UR) decisions and MPN information to the workers' compensation medical bills
• Reviews bills for facility charges, surgical bills, ambulance services and med-legal reports
• Takes an active role in reviewing appeals/reconsiderations as well as "Review Only" bills
• Reviews all bills in excess of a specific dollar threshold as determined by management
• Reviews all DRG bills to ensure properly coded
• Assists with quality/batch prep reports to ensure accuracy of reviews before they are returned to the file
• Assists in identify billing issues strategies to address the issues
• Works in close coordination with the Adjuster and Utilization Review team for the accurate completion of all bill review actions
• Completes a minimum standard of 130 reviews per day
• Acts as a resource for the WellComp Service Center Team
• Other duties as assigned

EDUCATION:

• BS/BA or Equivalent Work Experience/Education

EXPERIENCE:

• 3+ years of professional work experience
• Previous work in medical claims or medical billing

  SKILLS/ABILITIES:

• Ability to think through processes and documentation
• Must be able to take direction and add thought to process
• Strong communication and collaborative skills
• Strong Organizational and efficiency skills
• Effective and accurate verbal and written skills

  KNOWLEDGE:

• Official Medical Fee Schedule
• CPT Codes (Current Procedural Terminology)
• Medical Terminology