Bill Reviewer, Workers’ Compensation

Insurance Placement Solutions (IPS) has an immediate opening for a Bill Reviewer, Workers’ Compensation, with our client in Rocklin, California. Candidates must have experience in workers’ compensation medical bill review, strong knowledge of medical coding and fee schedules, and the required Medical Bill Reviewer certification.

In this role, you’ll review, audit, and process workers’ compensation medical bills to ensure accurate reimbursement in accordance with applicable fee schedules and regulations. You’ll evaluate billing codes, verify medical necessity, resolve billing discrepancies, and process reconsideration requests while maintaining established quality and productivity standards.

Bill Reviewer, Workers’ Compensation Responsibilities

• Review, audit, and process workers’ compensation medical bills accurately and efficiently
• Enter and code medical bills into the claims system while meeting established production and quality standards
• Evaluate billed services for appropriateness and medical necessity
• Apply CPT and ICD-9/ICD-10 codes and workers’ compensation fee schedules to determine appropriate reimbursement
• Review and reprice medical bills in accordance with applicable fee schedules and reimbursement guidelines
• Evaluate hospital and surgical bills using applicable fee schedules
• Identify billing discrepancies, coding issues, and unlisted procedures for supervisory review
• Process medical bill reconsideration requests as assigned
• Communicate with medical providers and clients to clarify billing information and resolve discrepancies
• Respond to provider inquiries regarding medical bill review when needed
• Maintain accurate billing records and documentation within the company system
• Ensure compliance with applicable workers’ compensation regulations and billing requirements

Qualifications

• Minimum of 1 year of data entry or medical billing experience
• Minimum of 2 additional years of medical bill review experience in a workers’ compensation environment
• Strong knowledge of CPT and ICD-9/ICD-10 coding
• Experience applying workers’ compensation medical fee schedules and reimbursement guidelines
• Experience reviewing hospital and surgical bills
• Familiarity with workers’ compensation regulations and medical bill review systems
• High school diploma or GED required

Technical Skills

• Proficiency with medical billing and bill review software
• Working knowledge of Microsoft Word, Excel, and database applications

Licensing & Certifications

• Medical Bill Reviewer designation with 40 hours of initial certification training required
• Must meet continuing education requirements of 16 hours every 2 years

Work Arrangement

• Position based in Rocklin, California

About Insurance Placement Solutions

Insurance Placement Solutions is a staffing and recruiting firm specializing in the insurance industry. We connect talented professionals with temporary, temp-to-hire, and direct-hire opportunities at leading insurance organizations across the United States.

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