Bill Review Associate II

Job Track Description: Performs tasks based on established procedures. Uses data organizing and coordination skills to perform business support or technical work. Requires vocational training, certifications, licensures, or equivalent experience. General Profile Expands skills within an analytical or operational process.

Maintains appropriate licenses, training, and certifications. Applies experience and skills to complete assigned work. Works within established procedures and practices. Works with a moderate degree of supervision. Functional Knowledge Has developed skillset in a range of processes, procedures, and systems. Business Expertise Understanding of how teams integrate and work best together to support the achievement of company goals.

Impact Impacts a team, by example, through the quality service and information provided Follows standardized procedures and receives moderate supervision and guidance. Leadership Has no supervisory responsibilities. Manages own workload. Problem Solving Uses existing procedures to solve standard problems without supervisory approval.

Interpersonal Skills Exchanges information and ideas effectively. Responsibility Statements Audits payment determination, reconsiderations, and re-reviews on Medical Bill Data. Assists in assigning procedure codes regarding complex issues and comprehensive exam codes. Examines and adjusts lower-level technical bills, including high-level office visits, reports, and record reviews.

Analyzes medical reports, test results, and treatment plan to determine proper payment or reimbursement. Maintains reference library of company and industry reimbursement policies Conducts test studies for the compliance team, requiring high-quality results and strict deadlines. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

Experience in medical bill review, claims processing, or a related field preferred. Strong analytical and attention-to-detail skills. Proficiency in Microsoft Office applications and relevant bill review systems. Ability to interpret medical documentation and reimbursement policies. This position requires working on a Graveyard (GY) Shift schedule.

Willingness to work overnight hours, weekends, holidays, and overtime as business needs require.