JOB POSTING IS EXPIRED
Bill Review Processor

PRIMARY PURPOSE: To supervise expense bill reviewers in needs assessment and implementation of timely cost-effective fee management services in compliance with corporate/jurisdictional standards; to provide review of technical, complex claims requiring extensive skills/experience; and to interact with expense bill reviewers, utilization review nurses, and claims staff to resolve problems and/or implement and improve workflow and communication.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Performs senior position duties, including one or more of the following: train expense bill reviewers; organize and assign workload; monitor performance; manage performance reviews; and assist with complex bill reviews.
• Reviews and maintains standards of turnaround expectation, customer satisfaction expectations.
• Works directly with reviewers to assure effective results through skilled, efficient services.
• Maintains knowledge and familiarity with corporate quality standards; ensures consistent application.
• Assures maintenance of productivity standards within acceptable error rate.
• Reviews bills using experience-gained knowledge of fee schedule and medical terminology; maintains knowledge of all bills regardless of complexity of claims, levels of service, or multiple jurisdictions.
• Ensures good results to our customers; provides quality customer service in oral and/or written communication.
• Develops and maintains tracking and quality assurance reports; obtains and reviews operational reports; and develops and implements operational revisions as necessary to improve service or unit efficiency.
• Acts as liaison between claims staff, nursing staff, medical bill payment team, and expense bill reviewers.
• Responds to written or verbal requests from vendors, insurance carriers, legal representatives, and injured workers by preparing documentation; may assist in preparing case testimony.
• Assists in maintaining customer relationships from a technical perspective; assists sales process/customer tours as necessary.
• Works with program manager, claims unit, expense bill reviewers to resolve questions, redesign workflow, and ensure efficient, accurate bills processing.  
• Participates in group meetings and training sessions.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).

SUPERVISORY RESPONSIBILITIES

• Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
• Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
• Provides support, guidance, leadership and motivation to promote maximum performance.

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred.

Experience

Six (6) years of experience in workers compensation claims processes with experience in state regulatory issues for payment of expense bills or equivalent combination of education and experience required.

Skills & Knowledge

• Knowledge of legislative environment and the market place
• Good customer service skills
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Leadership/management/motivational skills
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When 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 deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

The 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.