Bill Review Associate I
The Bill Review Associate reviews bills by following state, federal guidelines and fee schedules. Researches and applies other rules and edits to obtain enhanced savings for our clients. Interact with providers and Claim Professionals as necessary to deliver accurate and efficient bill processing. Communicate and provide timely responses to emails and phone calls from Internal and External customers.
GENERAL DUTIES & RESPONSIBILITIES:
- Learns or remains current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing.
- Provides subject matter expertise on billing and coding guidelines and regulations as required by the department.
- Identifies trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing.
- Reviews & researches and initiates the resolution of billing errors.
- Researches state agencies for upcoming changes in laws and fee schedules.
- Provides guidance to Management regarding changes in laws and fee schedules.
- Communicates with Sales to solve pricing issues and payment discrepancies.
- Works daily billing file spreadsheet.
- Responds to inquiries from internal departments regarding billing.
- When unable to resolve the problem in a reasonable amount of time, escalates to the appropriate resource. Follows up on escalated issues with coaching and mentoring to learn the appropriate solution and expand overall knowledge.
- Meets the standards of the job, such as quality standards and adherence to schedule.
- Performs other related duties as assigned
- A high school diploma or GED is required for this role.
GENERAL KNOWLEDGE, SKILLS & ABILITIES:
- Knowledge of Billing rules and regulations and federal and state regulations.
- Excellent customer service skills that build high levels of customer satisfaction.
- Effective verbal and written communication skills.
- Computer navigation and operation skills.
- Detail-oriented with good organizational skills.
- Ability to manage multiple tasks.
- Ability to work both independently and in a team environment.
- Ability to maintain confidentiality
Bill Review Associate I
Entry level role. Applies basic skills with moderate level of proficiency. Generally performs basic billing review/resolution processing and handles inquiries by following standard scripts and procedures. Works under close supervision without latitude for independent judgment. Consults with senior peers and team leads on non-complex issues to learn through experience. Typically authorized to make decisions regarding items under $500 without receiving approval from a team lead or supervisor. Typically requires one or more year’s customer service experience. One or more years of financial services experience and prior bill review experience is preferable.
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