Medical Bill Analyst
States we employ in: AL, AZ, CO, FL, GA, IL, IN, KY, MD, MO, NC, OH, SC, TN, TX, VA, WI, WV
The Medical Bill Analyst makes sound determinations to share, deny or pend medical bills based on Medi-share Guidelines, researches diagnoses and treatment plans on bills to ensure accuracy and necessity, issues payments, denials of payment, or requests for information from providers or members to make sound determinations.
Essential Job Duties & Responsibilities
Investigate and determine eligibility of medical bills according to Medi-Share program guidelines
Accurately and efficiently complete all necessary steps to properly adjudicate a medical bill
Agility to move between several different computer software systems in order to gather information, research and complete processing of medical bills.
Communicate verbally and in writing with other departments as necessary to gather proper information to make bill determinations
Proficiency in the use of the internet including e-mail and search engines, word processing and keyboard skills of at least 30 words per minute, ability to use a database system including how to update fields, basic knowledge of Microsoft office (Excel, Word and Outlook) and knowledge of a document imaging system.
All other duties as assigned
Essential Skills & Abilities
Strong analytical skills – ability to diagnose complex problems and issues with data not easily understood
Strong computer skills – ability to access and research complex medical procedures and terminology
Reading comprehension – ability to read large amounts of data in short periods of time and translate that information to make sound decisions on members’ medical bills
Mathematical Skills - Ability to add, subtract multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Ability to compute percent and to interpret bar graphs.
Language Skills - Ability to read and interpret electronic documents such as procedure manuals, medical records, medical bills, legal documents and insurance documents.
Reasoning Ability - Ability to apply common sense understanding to carry out instruction furnished in written, oral or diagram form. Ability to deal with problems involving several variables in standardized situations.
Ability to work effectively and independently without supervision in a remote setting
Core Competencies/Demonstrable Behaviors
Manages complexity—Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
Decision quality—Makes good and timely decisions that keep the organization moving forward.
Plans and aligns—Planning and prioritizing work to meet commitments aligned with organizational goals.
Ensures accountability—Holds self-accountable to meet commitments.
Optimizes work processes—Knowing the most effective and efficient processes to get things done, with a focus on continuous improvement.
Instills trust—Gains the confidence and trust of others through honesty, integrity, and authenticity.
Education and/or Experience
High School diploma or GED with basic knowledge of medical terminology required.
Medical coder or previous processing experience or knowledge of ICD10 and CPT codes preferred.
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. This document does not create an employment contract, implied or otherwise, other than an "at will" relationship.
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