WC Medical Bill Review Customer Service Rep

Riverside, California (US)
Based on experience + benefits
Feb 27, 2019
Apr 28, 2019
Job Type
Full Time

Keenan & Associates is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. We have seen continuous growth and success, and are positioned to lead the industry into the 21st century.

We currently have an exciting career opportunity for a Worker's Compensation Medical Bill CSR in our Torrance and/or Riverside locations. The WC Medical Bill CSR will respond accurately and promptly to telephone inquiries regarding bill adjudication, fee schedule allowances, IBR process, and appeals process.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned:

• Expected to take 6 calls per hour/48 calls per day to meet the set standard of production. • With the average speed of answer (ASA) of 30 seconds and an abandonment rate of 3%. • Expected to reach the goal of 20 minutes of after call work per day. • Call hold times should not exceed 2 minutes without following up with the caller. • Understanding of the California Official Medical Fee Schedule (OMFS) in order to provide current and accurate information to a caller. • 100% documentation is expected for each call received. • Call quality should be at 90% and above for all call quality audits. • Escalated issues should be followed up within 5 business days of receipt. • Attendance is an essential part of the job function and excessive unscheduled tardiness or absenteeism's will be addressed individually. • Provide customer service to providers. • Expected to process at least 35 appeals with calls and 65 appeals without calls with an accuracy rate of 98%. • Request additional information from external sources when required. • Review complex or unusual claim situations • Review claims previously processed incorrectly and forward to management with recommended correction process • Handle claim processing/adjustments as needed • Issue written correspondence to providers. • Record call data in call tracking system. • Research claims status. • Other duties as assigned.

MINIMUM SUGGESTED QUALIFICATIONS: Needs to hold a current Experienced Medical Bill Reviewer Designation meeting the requirements for Workers’ Compensation medical bill review. IEA 101 and Medical Terminology courses helpful. Prior customer service background required. Excellent verbal and written communication skills. Highly developed organizational abilities. Prior keyboarding experience. Must be proficient in Microsoft Windows and Outlook.

MINIMUM EDUCATION: High School Diploma or GED required; Certified Medical Coder (CPC) designation a plus.

Keenan provides a competitive compensation and benefits package. We encourage teamwork and employee initiative - people working together is what makes Keenan a success. We invite you to share in the commitment of preserving our warm tradition, reputation and dedication to our clients. After all…What you do makes a difference!

Please submit your resume to msun@keenan.com.

Keenan provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, veteran, marital, or domestic partner status. Keenan is committed to a diverse workforce and is an affirmative action employer.