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Medical Bill Coordinator

Company: Sedgwick Claims Management Services, Inc.
Location: Franklin
Posted on: April 27, 2021

Job Description:

The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.Medical Bill CoordinatorIF YOU CARE, THERE'S A PLACE FOR YOU HEREFor a career path that is both challenging and rewarding, join Sedgwick's talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets-their employees, their customers and their property. At Sedgwick, caring counts. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of othersSedgwick's bill review services are part of a customized solution for clients that ensures medical bills are paid timely and at the appropriate cost. Our utilization review (UR) nurses and bill reviewers look for all possible savings and use the most accurate re-pricing system available to make sure bills are paid appropriately based on state rules and regulations, UR treatment plans, clinical edits and other applicable reductions.PRIMARY PURPOSE: To review hospital and professional medical bills from provider including complex hospital, surgical, high level evaluation and management codes, and/or technical bills.ESSENTIAL FUNCTIONS and RESPONSIBILITIES Processes bills in accordance with multi state schedules, rules, regulations, and guidelines. Applies PPO contract discounts to bills. Reviews operative reports to determine if surgery services were appropriately billed. Reviews complex medical, legal and consult services. Contacts client or facility to obtain additional or missing information. Handles provider appeals where appropriate to fee schedule and contractual disputes. Communicates internal issues to management. Assists bill review team lead with workflow management, coaching and mentoring of staff. Assists with process, procedure and system training for new staff.ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s). Travel as required.QUALIFICATIONSEducation & LicensingHigh School diploma or GED required.ExperienceTwo (2) years workers' compensation and/or bill review experience or equivalent combination of education and experience required to include provider appeals experience. PPO re-pricing, surgery review, by report and RNE review preferred. Two (2) years of experience with complex medical, legal, and consult review preferred.Skills & Knowledge Knowledge of re-pricing rules and guidelines Knowledge of medical terminology, anatomy and surgical terms Knowledge of multiple state jurisdictional regulations and rules Knowledge of Fee Schedules, Rules, and U&C Guidelines Knowledge of CPT/ICD9 PC literate, including Microsoft Office products Leadership skills and ability to motivate others Strong verbal and written communication skills Strong interpersonal skills High level of accuracy and attention to detail Ability to multi-task and function in high volume area Ability to handle deadlines and proactively problem solve Ability to work in a team environment Ability to meet or exceed Performance CompetenciesWORK ENVIRONMENTWhen applicable and appropriate, consideration will be given to reasonable accommodations.Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlinesPhysical: Computer keyboarding, travel as requiredAuditory/Visual: Hearing, vision and talkingThe statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Keywords: Sedgwick Claims Management Services, Inc., Franklin , Medical Bill Coordinator, Healthcare , Franklin, Tennessee

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