Job Description
Position Overview:
We are seeking a detail-oriented professional to handle essential processes in applying PPO guidelines to medical bills. In this role, you'll ensure accuracy and timeliness in managing these manual processes, contributing to the overall efficiency of our billing operations.
Key Responsibilities:
Provider Identification: When automated systems cannot determine a provider's participation status, you'll manually identify whether they are participating or non-participating.
Guideline Application: Accurately apply PPO guidelines to bills where a participation match has been made, especially when automated systems are unable to do so.
Client and Internal Communication: Collaborate with clients and internal Bill Review teams via email or phone to:
Request necessary bill images or documentation for proper PPO discount application.
Address keying errors or discrepancies, ensuring corrections are made for accurate PPO discount application.
PPO Application Support: Work closely with the PPO Application team through various communication channels to resolve questions or concerns about specific bills, policies, or procedures.
Rate Calculation: Utilize relevant software and documentation to calculate contracted rates, which may involve the calculation of AWP, Medicare, or state/federal-mandated fee schedules.
Quality Assurance Assistance: Support the Senior PPO Application Specialist in quality assurance processes as needed.
Qualifications:
Education: High School Diploma or equivalent is required.
Experience & Skills:
Knowledge of medical billing processes, including familiarity with CPT Codes, Revenue Codes, Bill Types, ICD-9 and/or ICD-10 Codes, State Fee Schedules, UCR, and PPO.
Proficiency in using Windows-based software and applications.
Strong attention to detail with accurate typing skills.
Ability to review documentation and make informed decisions based on established department policies and procedures.
Team-oriented with a collaborative spirit.
Self-motivated with a proactive approach to work.
Equal Opportunity Employment:
We are committed to providing equal employment opportunities to all employees and applicants, ensuring a workplace free from discrimination and harassment. We welcome applicants from all backgrounds and do not discriminate based on race, color, religion, age, sex, national origin, disability, genetics, veteran status, sexual orientation, gender identity, or any other characteristic protected by law. This policy applies to all aspects of employment, including recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour
Job Tags
Hourly pay, Full time,