Bill Review Services Associate III

About Conduent:

• 
  Excellent communication skills
• Keyboarding and MS Office proficiency
• Ability to successfully complete a mandatory two weeks paid training program
• Great problem-solving skills
• Ability to effectively multi-task
• High school diploma, GED, or college degree
• Must have the ability to pass a background check, potentially including Employment and Education verification
• Must be 18 years or older

• 
  Reviews specialized Medical Bills, which includes hospital, surgery and high-level phycian bills for workers compensation and non-workers compensation claims and may include hospital bills, auto liability, usual and customary reimbursement.
• Determines the appropriateness of a final reimbursement outcome by making the distinction between and knowing when to apply either Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction
• Communicates and defends to providers and clients the basis for the methodology used to accomplish the reduction of charges.
• Analyzes and reviews high-level office visits, reports, and record reviews.
• Interprets hospital review guidelines for both inpatient and outpatient claims.
• Conducts test studies for the Compliance Team which often require aggressive deadlines with accurate, high-quality results.

Job 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.

• Proficiency within a range of analytical or operational processes.
• Completes atypical assignments.
• Works within established procedures and practices.
• May establish the appropriate approach for new assignments.
• Acts as a resource for colleagues.
• Completes work with limited supervision.

• Has developed skills in a range of processes, procedures, and systems.

• Understanding of how teams integrate and work best together to support the achievement of company goals.

• Impacts a team, by example, through the quality service and information provided.
• Uses discretion to change work procedures and practices.

• May provide guidance and support to junior team members.

• Provides solutions to atypical problems based on existing precedents or procedures.

• Exchanges information and ideas effectively.

• Reviews specialized Medical Bills including hospital, surgery, and high-level physician bills.
• Establishes the appropriateness of a final reimbursement outcome by making the distinction between and knowing when to apply either Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction.
• Communicates and upholds the basis for the methodology used to accomplish the reduction of charges.
• Analyzes and reviews high-level office visits, reports, and record reviews.
• Interprets hospital review guidelines for both inpatient and outpatient claims.
• 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.

Closing: