Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.
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Specialist Bill Review II
PRIMARY PURPOSE: To review hospital and professional medical bills from provider including complex hospital, surgical, high level evaluation and management codes, and/or technical bills.
ESSENTIAL FUNCTIONS and RESPONSIBILITIESProcesses bills in accordance with multi state schedules, rules, regulations, and guidelines.Applies PPO contract discounts to bills.Reviews operative reports to determine if surgery services were appropriately billed.Reviews complex medical, legal and consult services.Contacts client or facility to obtain additional or missing information.Handles provider appeals where appropriate to fee schedule and contractual disputes.Communicates internal issues to management.Assists bill review team lead with workflow management, coaching and mentoring of staff.Assists with process, procedure and system training for new staff.
ADDITIONAL FUNCTIONS and RESPONSIBILITIESPerforms other duties as assigned.Supports the organization's quality program(s).Travel as required.
QUALIFICATIONS
Education & LicensingHigh School diploma or GED required.
ExperienceTwo (2) years workers' compensation and/or bill review experience or equivalent combination of education and experience required to include provider appeals experience. PPO re-pricing, surgery review, by report and RNE review preferred. Two (2) years of experience with complex medical, legal, and consult review preferred.
Skills & KnowledgeKnowledge of re-pricing rules and guidelinesKnowledge of medical terminology, anatomy and surgical termsKnowledge of multiple state jurisdictional regulations and rulesKnowledge of Fee Schedules, Rules, and U&C GuidelinesKnowledge of CPT/ICD9PC literate, including Microsoft Office productsLeadership skills and ability to motivate othersStrong verbal and written communication skillsStrong interpersonal skillsHigh level of accuracy and attention to detailAbility to multi-task and function in high volume areaAbility to handle deadlines and proactively problem solveAbility to work in a team environmentAbility to meet or exceed Performance Competencies
WORK ENVIRONMENTWhen applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($17.17 - $22.00). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.