Medical Bill Review Auditor

Full time position in Dallas, TX metro area - NOT A REMOTE POSITION

MUST BE highly proficient with computer usage and Microsoft Office products. MUST HAVE Knowledge of CPT, ICD-9/10 and HCPCS codes along with commonly used concepts and practices in Workers Compensation medical bill review/auditing. Prepares and compiles medical provider bill data for Workers Compensation clients.

The successful candidate will be expected to complete a minimum of 85-90 medical provider bills on average per day, verified through the system User Tracking module by Manager and maintain a monthly average of 98% medical bill accuracy rate in QA reporting. Candidate should demonstrate understanding of medical bill review guidelines, modifiers and procedures as well as demonstrate a higher level understanding for complex medical bills (hospital and surgery). It will be necessary to master all processing rules as necessary for all current clients and ensure appropriateness of billed treatments to accepted compensable WC injury.

after successful completion of 60-90 days training, eligible for hybrid schedule of 3 days remote/report in person 2 days in office.

Knowledge, skills, education and/or experience

• Knowledge of CPT/ICD-9/10 codes and medical terminology
• Requires previous bill review/audit experience in Texas Workers' Compensation related to bill auditing
• Critical thinking skills and decision making ability
• 2-4 years of medical office experience or healthcare background experience required
• High school diploma or its equivalent; prefer additional training/certification in medical terminology

Candidate must possess the ability to examine medical records for completeness and accuracy to client standards. Oral and written communication techniques which include face-to-face discussions with individuals and team are a necessity. Must have high proficiency in data entry and ten-key by touch. It is important to demonstrate a full understanding of the system application of payment recommendations based on Texas WC Fee Schedule, UCR, Medicare payment policy guidelines and other incorporated items, such as preauthorization, PLNs, Peer Review, RME, DDE and Retrospective review decisions. Should be familiar with the various forms and codes, such as 99455-V3, Texas Labor Code S408.027, DWC66, ODG, PEER review, -SG Modifier, -TC Modifier and -26 Modifier and be very familiar with the musculoskeletal parts of the human body.

Should meet or exceed client expectations related to specifics of account assigned and adhere to and meet IMO's regulated guidelines and mandated timeframes. Important to be efficient in coding data from medical records as well as proficiency with electronic mail, various software programs, fax and phones. An exceptional ability to make problem solving decisions and prioritize items that accurately reflect the relative importance of the job.