Medical Bill Review Analyst

Company Overview

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

 

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

Job Description

This is a remote position and candidates must be willing to work an Eastern/Central Time Zone schedule.

• Applies Certified Coder knowledge and logic to process routine to complex claims and electronic work queues in accordance with company policies and procedures.
• Interprets and processes systems edits by using Documentation Guidelines as it pertains to each state.
• Ensures all CPT coding regulations are followed as they apply to each system edit and state fee schedule.
• Researches information by effectively using the State Reference Guides as a resource.
• Follows client protocol and implementation dates as they pertain to each individual client.
• Acts independently and manages own activities with minimal supervision and direction to meet customer needs using sound decision making.
• Maintains production and claims quality standard.

Qualifications

Education: 

• High School Diploma or equivelant.
• CPC - American Academy of Professional Coders designation as Certified Professional Coder.

Experience/ Skills:

• 2+ years of recent experience working with CPT (Current Procedural Terminology) with knowledge of (2016-2022)/ CPT Modifiers/HCPCS /ICD-9/ICD-10 coding guidelines.
• 2+ years experience in Evaluation and Management. Specifically related to 2021 AMA CPT changes.
• 3+ years experience in claims processing (original and reconsideration) for Medical Bill Review or Clinical Code Review in Worker’s Compensation.
  • Down coding E/M, Outpatient Coding, Radiology-3D Imaging, Acupuncture, Hospital E/M, Fluoroscopy, Lacerations, Unlisted codes. Physical therapy timed Codes.
• Working knolwedge of medical terminology related to Anatomy and Physiology.
• Effective keyboard skills; able to navigate within a computer/systems-dependent environment without assistance; previous experience in a windows-based computer environment preferred (including MS Windows, MS Office, MS Excel, MS Word, Outlook).
• Strong verbal and written communication skills, and proven analytical thinking required.
• Effective time management skills.
• Effective analytical and problem-solving skills.

Highly Desired: 

• CEMC - American Academy of Professional Coders designation as Certification Evaluation Management Coding.
• CPMA - American Academy of Professional Coders designation as Certification Professional Medical Audit.
• Remote work experience with electronic records on a Bill Review platform: Smart Advisor.

Benefits
We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $20.00 - $26.50 hourly, and will be based on a number of additional factors including skills, experience, and education.The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.Don't meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.#LI-MC1#LI-Remote#MIT