Loading...
 
Share this Job
Apply now »

Medical Bill Review Specialist II *NY candidates*

8687

We are Farmers!

Join a team of diverse professionals at Farmers to acquire skills on the job and apply your learned knowledge to future roles at Farmers. Farmers Insurance also offers extensive training opportunities through the award winning University of Farmers named by Training magazine amongst top 10 corporate training units in the world.

Job Summary

Purpose of this role is to support Claims by analyzing medical, hospital, durable medical equipment, pharmacy, home health, etc. bills and records/reports to determine billing accuracy and appropriateness. This support is achieved by utilizing intelligent software and by understanding and applying knowledge of medical code billing and claims processing rules and regulations, billing practices, code sets, and state and Medicare adjustment reimbursement principles. Support is also achieved by developing and providing education and training regarding provider billing and documentation, identifying and bringing to management’s attention any unusual or emerging procedures or billing anomalies, and by supporting SIU, Litigation and BLO units through preparation assistance and testimony at hearings, arbitration, and trials as deemed appropriate.

Essential Job Functions

  • Use intelligent software and understanding of state Med Pay/PIP laws, claims practices and other medical billing knowledge to review medical bills and records to determine if the bills are coded correctly.
  • Review system-generated coding overrides, based on override reasons.
  • Contact providers to discuss coding used in billing to determine appropriateness.
  • Manually override coding as appropriate and permitted by state. Partner with Claims Training to create, review and update curriculum related to medical billing.
  • Provide guidance and training on billing codes, procedures, emerging treatments, etc. to MedPIP and occasionally BI/UM Claims employees.
  • Roundtable bills and claims with MedPIP and occasionally BI/UM Injury Claims employees to aid in determining if billing is accurate and appropriate for treatment provided.
  • Routinely assist Litigation Claim Handlers and BLO in reviewing litigated billing matters and assist in preparing questions for provider depositions.
  • Prepare bill review memorandums when needed.
  • Attend depositions and testify regarding AMA billing standards and other related topics as necessary.
  • Assist Claims, SIU and Major Ops in identification and evaluation of potential fraudulent billing practices.
  • Perform data review, analysis, special projects, and other duties as assigned.

Education Requirements

  • High school diploma or equivalent required.
  • Associates degree preferred or equivalent work experience
  • Certified Professional Coder certification such as CCA. CCS, CCS-P, CPC, CPC-P from a generally recognized professional organization such as AHIMA or AAPC

Experience Requirements

  • Three or more years of experience in a medical coding role preferred.
  • Prior experience in a payer environment working with claims systems and bill review software required.

Special Skill Requirement

Intermediate computer skills, Basic knowledge of Microsoft Excel, Microsoft Word, Strong communication, and collaborative skills, Strong organizational skills, Strong analytical skills.

Job Location(s): US - NY - Remote

Want to learn more about our culture & opportunities? Check out farmers.com/careers and be sure to follow us on Instagram and LinkedIn!

Apply now »