
- Junior
- Escritório em Pune
Key Responsibilities
Additional responsibilities include:
- Process Workers’ Compensation medical bills for payment according to specific state Workers'
- Compensation fee schedule and beyond via system entry and software
- Accurate data entry and adjudication of provider bills in the Corrus computer system according to state Workers’ Compensation Fee Schedule rules, with satisfactory volume and error ratio.
- Analyze, review and recommend payment to medical providers based upon statutory rules or guidelines and/or provider reimbursement contract amounts to achieve maximum cost savings, to the level appropriate in terms of:
- Medical necessity
- Treatment actually rendered
- Adjuster authorizations
- Usual or reasonable and customary charges
- Utilization practices
- Applicable fee schedules
- Contracted agreements
- DRG validation
- Utilize Fee Schedules, online document, client instructions and other training material to properly review medical bills
- Research usual and customary/Fee Schedule applications as appropriate
- Ensure timely payments to providers meet statutory regulations on the type and amount of reimbursement and significantly reduce costs
- Handling of provider and customer phone calls
- Training on an on-going basis to increase knowledge with State Fee Schedule, medical terminology, use of reference materials, e.g. CPT, ICD-10, HCPCS
- Perform other duties as requested
Skills, Knowledge & Expertise
- Minimum of one-year medical terminology/medical office experience, including working with medical providers and professionals
- Typing 60+ wpm/10-key by touch; heavy numerical data entry with high ratio of accuracy
- Produce 120 bills per day with an accuracy rate of 95%+
- Previous experience in specific state’s Workers’ Compensation Fee Schedule, CPT, ICD-10, HCPCS coding
- Familiarity with provisions and contents of other state WC programs, particularly in FL, GA, CA, SC, NC, VA, AL and TN
- Proficient with the use of Microsoft Office Suite
- Ability to effectively operate a personal computer and related claims and business software
- Proactive, independent, and takes initiative with consistent follow through
- Superb communication skills, verbal and written, conducted in a timely manner
- Superior time management skills with capability of working with and meeting deadlines
- Exceptional capability to multi-task and prioritize with excellent organization and
- documentation skills in a fast-paced, dynamic work environment
- Excellent team player with interpersonal skills
- High level attention to detail and problem-solving skills
- Capable of working collaboratively and independently with minimal supervision
- Exhibit discretion with sensitive and confidential information
- Must speak English
- Excellent communication, verbal and written skills conducted in a timely manner
- Proficient with Microsoft Office Suite especially Word, Outlook, and Excel
- Demonstrate significant ability to enter data correctly