Review specialist

Overview

JOB DUTIES

Find out more about the daily tasks, overall responsibilities, and required experience for this opportunity by scrolling down now.

Responsible for performing timely review of charges in the charge review WQS. Verify completeness of the charge information, add and / or update as needed.

Essential Functions

• Accurately perform actions on the charges in the charge review WQS for each patient encounter.
• Review, verify, and interpret payor edits in the system.
• Timely identify, research, and resolve issues that may cause delays in resolution.
• Inform Team Leader on the status of work and unresolved issues. Alert Team Leader of backlogs or issues requiring immediate attention.
• Identify clinic trends and provide essential reporting functions as required.
• Perform special projects as assigned by the Team Lead or Manager.
• Respond and send emails to different levels of management within the Business Groups, Clinics, etc. to resolve charge issues.
• Review and work assigned WQ’s on a daily basis to make any corrections, resolve edits, and submit to the payor.

Temperament

Adhere to company policies and procedures, demonstrate the core values and hospitality behaviors, resolve conflict through open, honest, professional communication, demonstrate a positive and enthusiastic attitude, keep supervisor and leadership apprised of issues, and seek opportunities to recognize others.

Qualifications

SKILLS, QUALIFICATIONS, AND REQUIRED EXPERIENCE

• Possesses critical thinking, prioritization, and organizational skills.
• Attention to detail and quality of work.
• Basic computer literacy and arithmetic skills.
• Ability to organize and prioritize assignments to work independently as well as a collaborative team member.
• Customer service experience working with internal & external clients.
• Strong analytical and problem-solving skills.
• Ability to communicate effectively and courteously, both orally and in writing.
• Handles confidential health information in compliance with HIPAA.
• Strong telephone skills.
• Ability to operate standard business equipment, e.g., copier and fax machine.
• Working knowledge of HMOs, Medicare, Medicaid, PPO, and third-party payers.
• Knowledge of CPT and ICD codes and medical terminology.
• Strong PC skills required using Excel and Word.
• Ability to work as a team is essential to the individual's success.

Experience Requirements

• 2 years of computer experience in medical billing required.
• 2 years of healthcare experience in medical billing preferred.
• 2 years of experience with medical billing software required.
• 2 years of experience with online payor tools preferred.

Education Requirements

• High School Diploma or GED equivalent required.
• Associate's degree preferred.

Certification / Licensure Requirements

Medical Terminology Certificate preferred at the time of hire.

UFJPI is an Equal Opportunity Employer and Drug-Free Workplace.

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Last updated : 2024-09-30