Medical Bill Reviewer I

Sentry Insurance Agency • Stevens Point, WI

3d • Onsite

About The Position

Join our Medical Bill Review team to ensure accurate processing of wage loss and medical claims using applicable laws; manage routine bills and escalate complex issues. This position will be staffed out of our Stevens Point, WI office and is NOT available for remote work. What You'll Do As a Medical Bill Reviewer I, you will: Review, and evaluate in accordance with state regulations and established guidelines, processes original medical, dental, and pharmacy bills. Evaluate bill data in compliance with medical bill processing guidelines. Identifies errors and makes corrections when possible. Determines the completeness of a bill and evaluates whether the bill can be sent back to the provider for required information in accordance with state guidelines. Complete and submit state mandated forms regarding bill review reductions and/or denials in accordance with jurisdictional requirements. Review and issue payment of vendor bills related to claim handling which may include bills for mileage, copy service, court reporters, IME, surveillance, non-emergency transportation, interpreter, utilization review, non-medical consulting, nurse case manager, etc. Use state reference guides and websites, medical bill coding reference material, and rules built into the bill paying system to determine appropriate resolution and payment of billed item. Researches and analyzes provider NPIs/license numbers. Additionally, you will: Responds to inquiries from, medical providers, attorneys, insured, claimants, and other internal company employees regarding payment for services provided. May communicate with medical providers regarding payment or denial of payment.

Requirements

• Technical Degree or equivalent work experience
• High level of communication, customer services and telephone skills required
• 1 or more years of related work experience in a medical office, insurance environment, or medical coding beneficial
• Basic knowledge of ICD9/IDC10, CPT, HCPCS codes necessary for accurate processing
• PC knowledge including Excel as well as keyboarding, math aptitude, and organizational skills
• Proficient analytical and decision making skills with the ability to work independently
• Ability to work within deadlines, maintain confidentiality, and work with detail and a high level of accuracy is essential

Nice To Haves

• Technical diploma or Associate Degree in Health Informatics/Health Information/Medical Coding preferred
• 1 or more years of related work experience in a medical office, insurance environment, or medical coding beneficial

Responsibilities

• Review, and evaluate in accordance with state regulations and established guidelines, processes original medical, dental, and pharmacy bills.
• Evaluate bill data in compliance with medical bill processing guidelines.
• Identifies errors and makes corrections when possible.
• Determines the completeness of a bill and evaluates whether the bill can be sent back to the provider for required information in accordance with state guidelines.
• Complete and submit state mandated forms regarding bill review reductions and/or denials in accordance with jurisdictional requirements.
• Review and issue payment of vendor bills related to claim handling which may include bills for mileage, copy service, court reporters, IME, surveillance, non-emergency transportation, interpreter, utilization review, non-medical consulting, nurse case manager, etc.
• Use state reference guides and websites, medical bill coding reference material, and rules built into the bill paying system to determine appropriate resolution and payment of billed item.
• Researches and analyzes provider NPIs/license numbers.
• Responds to inquiries from, medical providers, attorneys, insured, claimants, and other internal company employees regarding payment for services provided.
• May communicate with medical providers regarding payment or denial of payment.

Benefits

• At Sentry, your total rewards go beyond competitive compensation. Below are some benefits and perks that you’ll receive.
• Sentry is happy to offer flexibility through a scheduled Hybrid work model. Monday and Friday work from home if you choose to, Tuesday through Thursday you’ll work in office. As a Sentry associate, you will have an in-office workspace and materials for your home office. In addition to the laptop, you will receive prior to your start, Sentry will provide equipment for your home office.
• Meal Subsidy available for associates who report to an office.
• 401(K) plan with a dollar for dollar match on your first eight percent, plus immediate vesting to help strengthen your financial future.
• Continue your education and career development through Sentry University (SentryU) and utilize our Tuition Reimbursement program
• Generous Paid-Time Off plan for you to enjoy time out of the office as well as Volunteer-Time off
• Group Medical, Dental, Vision, Life insurance, Parental leave, and our Health and Wellness benefits to encourage a healthy lifestyle.
• Well-being and Employee Assistance programs
• Sentry Foundation gift matching program to encourage charitable giving.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 501-1,000 employees