Bill Specialist I

#LI-RG1

• Access and verify claim numbers in multiple claim systems, review file notes and the Claim Summary Windows and identify the correct claim number and claim.
• Review and interpret procedure codes (CPT), diagnosis codes (ICD-9), and nature of injury as indicated in the claim system to determine medical causality. Research claim information and authorize / pend bill for payment.
• Document reasons for pending bills to the BCO or provider and indicate any specific jurisdictional requirements, indication of fraud, or further information needed for bill processing. Communicate to Supervisor any pertinent information (i.e. discrepancies found in files, etc) to ensure an accurate and productive working environment.
• Identify employee and health privacy indicated claims and forward accordingly for appropriate processing.
• Utilize internal forms and notes to communicate findings to Branch Claims Offices and providers. May maintain verbal communication to collect facts and provide information relating to the processing of the bill.
• Access bill classification information to change Broadspire receipt date and account (BCO) receipt date.
• Utilize windows to view and interpret images of bills and reports. Enter information required to complete bill adjudication. Apply bill / form types and research codes. Research bills returned from the Branch Claims Offices and Providers.
• Assign resolution codes to complete bill processing.
• Meet required Quality / Production Standards while maintaining turnaround on assigned states. Ensure accurate and efficient processing; accurately report bills processed daily.
• May perform other duties as assigned.