Workers' Compensation Bill Review Specialist

Job Summary

Reviewing and processing workers' compensation medical bills, the full-time remote Bill Review Specialist will ensure compliance with state fee schedules and client guidelines while managing provider appeals and preparing reimbursement determinations.

Key Responsibilities

• Analyze and adjudicate various types of medical bills for reimbursement accuracy and compliance
• Research and investigate provider appeals and billing disputes, interpreting relevant regulations and guidelines
• Prepare professional correspondence explaining payment decisions and reimbursement methodologies to providers

Required Qualifications

• High school diploma or equivalent required; associate's degree or higher preferred
• 3 to 5 years of experience in workers' compensation bill review, including knowledge of state fee schedules and regulations
• Familiarity with CPT, ICD-10, and HCPCS coding systems
• Experience in managing provider appeals and billing disputes
• Preferred experience with Conduent Strataware and CompIQ software