Job Description

Purpose:
We're looking for a detail-oriented professional to handle the manual processes involved in applying PPO guidelines to medical bills, ensuring they are processed both accurately and on time.

Key Responsibilities:

Provider Identification: When our automated system can't determine if a provider is participating, you'll step in to identify them as participating or non-participating.
PPO Guidelines Application: Apply PPO guidelines to bills where participation matches are identified but not automatically processed, ensuring accuracy and compliance.
Communication:
Collaborate with clients and internal Bill Review teams via email or phone to request bill images or documentation when needed to apply PPO discounts correctly.
Address keying errors or discrepancies by communicating effectively to request corrections.
Work closely with the PPO Application team to resolve specific billing questions or general concerns about policies and procedures.
Rate Calculation: Use the appropriate software and documentation to accurately calculate contracted rates, including but not limited to AWP, Medicare, and applicable state or federal fee schedules.
Quality Assurance: Support the Senior PPO Application Specialist with quality assurance processes when necessary.
Education Requirements:

A High School Diploma is required.
Experience and Skills:

Medical Billing Knowledge: Familiarity with medical billing processes, including CPT Codes, Revenue Codes, Bill Types, ICD-9 and ICD-10 Codes, State Fee Schedules, UCR, and PPO.
Technical Proficiency: Experience with Windows-based software and applications.
Attention to Detail: Strong ability to type accurately and review documentation to make informed decisions.
Team Player: A desire to collaborate and work well with others.
Self-Motivation: Proactive and driven to initiate tasks and see them through to completion.
Equal Employment Opportunity Statement:

We are committed to providing equal employment opportunities to all employees and applicants. We do not tolerate discrimination or harassment of any kind, regardless of race, color, religion, age, sex, national origin, disability status, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by law. This commitment applies to all aspects of employment, including recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour

Job Tags

Hourly pay, Full time, Remote job,

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