The bill reviewer assesses itemized bills and participates in bill resolution/gate-keeping activity with outside vendors assisting CCM. CCM’s mission is to connect and equip Christians to share their lives, faith, talents and resources with others.
In This Role You Will...
View claims for appropriateness of charges on high dollar cases that exceed high dollar cases.
Review Member bills, ensuring correct medical coding has been applied
Before releasing bill for processing, perform quality audits by examining billing criteria, utilization review standards, as well as current audit criteria
Support current goals to increase in- house effort by selectively referring cases deemed appropriate for a contracted vendor
Continually seeks opportunities to improve performance and process
Keep audit queue with pended claims up to date in CSI for status checks by outside departments
Interpret medical records, lab results and radiological reports
Utilize a broad based knowledge of anatomy and physiology
Gather information on certain diseases/conditions via the internet or written material to enhance ability to understand conditions being reviewed
Accurately monitor cases referred to outside vendor with audit potential in accordance to the established audit criteria and the established processing timeline
Monitor any case activity surrounding bills and report any concerns or pertinent information to Manager
Effectively communicate with department managers, employees, providers and outside vendors
Work collaboratively with others and handle diverse responsibilities concurrently
Utilize strong interpersonal/communication skills which contribute to building and maintaining positive team dynamics
Maintain performance expectations in a stressful environment
Prioritize activities and effectively manage details
Take initiative to identify and complete job duties
Work for extended periods of time on the computer
Document all communication with providers, processing and other departments
Maintain required certifications/licensures
Assist in negotiating discounts on bills that are $25K or greater that have no audit/ bill review findings
Completing tasks in all assigned work flows
Offer to pray when opportunity presents itself
All other duties as assigned
In This Role You Must Be Able To…
Skill in written and verbal communication
Ability to navigate the internet including e-mail and search engines
Word processing skills
Knowledge of anatomy, physiology, and disease process
Ability to type at least 25 words per minute
Ability to use database systems including how to update fields
Basic Knowledge of Microsoft Office including Excel, Word and Outlook
Knowledge of document imaging system
Core Competencies/Demonstrable Behaviors
Ensures accountability-Holding self and others accountable to meet commitments.
Communicates effectively-Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.
Decision quality-Making good and timely decisions that keep the organization moving forward
Optimizes work processes-Knowing the most effective and efficient processes to get things done, with a focus on continuous improvement.
Education and Experience
High school diploma or GED
3+ years’ experience with utilization review, medical coding and/or patient financial services preferred
Familiarity interpreting medical records and writing detailed reports
Certified medical coder preferred
Statement of Faith *
You must be able to subscribe to the statements below without reservation:
We believe there is only one God eternally existing in three Persons: the Father, Jesus Christ and the Holy Spirit. (Deut 6:4, Col 1:15-20, Col 2:9)
We believe the Bible is God's written revelation to man and is verbally inspired, authoritative and without error (2 Tim 3:16,17)
We believe in the deity of Jesus Christ who existed as God before anything was created, His virgin birth, sinless life, miracles, death on the cross to provide for our redemption, bodily resurrection and ascension into heaven, present ministry of intercession for us and His return to earth in power and glory. He is the world's only Savior and is the Lord of all. (Col 1:15, Acts 4:12, Is 45:21-23)
We believe in the personality and deity of the Holy Spirit, that He performs the miracle of new birth in an unbeliever and indwells believers, enabling them to live a godly life. (Acts 5:3-4, Rom 8:14, 1 Cor 3:16)
We believe man was created in the image of God, but because of sin was alienated from God. Alienation can be removed by accepting God's gift of salvation by grace through faith (Eph2:8-10) which was made possible by Christ's death and resurrection. This faith will be evidenced by the works that we do. (James 2:17)
Conduct and Character *
CONDUCT & CHARACTER - It is our goal to reflect an authentic Christian community and to bring glory to the name of Jesus Christ through all the efforts and actions of the ministry and its employees. Therefore, we expect all employees to endeavor to live in accordance with our Christian beliefs.
TOBACCO USE - Our ministry is aimed at healthy lifestyles and therefore tobacco use is prohibited as a condition of employment.
U.S. Equal Opportunity Employment Information (Completion is voluntary)
Individuals seeking employment at Christian Care Ministry are considered without regards to race, color, religion, national origin, age, sex, marital status, ancestry, physical or mental disability, veteran status, gender identity, or sexual orientation. You are being given the opportunity to provide the following information in order to help us comply with federal and state Equal Employment Opportunity/Affirmative Action record keeping, reporting, and other legal requirements.
Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.
Race & Ethnicity Definitions
If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:
A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.
A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
Voluntary Self-Identification of Disability
Why are you being asked to complete this form?
Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities1. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self-identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
How do I know if I have a disability?
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
Disabilities include, but are not limited to:
Multiple sclerosis (MS)
Missing limbs or partially missing limbs
Post-traumatic stress disorder (PTSD)
Obsessive compulsive disorder
Impairments requiring the use of a wheelchair
Intellectual disability (previously called mental retardation)
Reasonable Accommodation Notice
Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
1Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal employment obligations of Federal contractors, visit the U.S. Department of Labor's Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp.
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