Sr Medical Services Rep
Description
Review, analyze and process basic to complex medical bills for relatedness and appropriateness. (Complexity is based on dollar amount of bill and treatment received/coding used) Applies technical knowledge and judgment to make accurate, timely, and compliant payment decisions while meeting production requirements. Uses advanced data entry skills and multiple applications simultaneously.,
Responsibilities
Audit medical bills for relatedness and appropriateness for WC or Auto claims, using critical thinking skills to make accurate, timely, and compliant payment decisions while meeting production requirements Identifies and resolves discrepancies in transactions/documents reviewed. Refers difficult or questionable transactions to Supervisor for assistance in resolution. Maintains appropriate transaction records and generates activity reports. Provides guidance and assistance to internal customers, providers, claimants, and/or policyholders on inquiries and problems and explains processing procedures, etc. Maintains relationships with internal and/or external customers and providers to ensure timely processing of transactions. Responds to customer/provider inquiries and creates and issues provider correspondence. Communicates with claims professionals, attorneys, and others to gather necessary information in order to complete transactions.
Qualifications
Knowledge of medical terminology, medical coding
Intermediate to advanced knowledge of Current Procedural Terminology (CPT), International Classification of Disease (ICD), and Health Care Common Procedure Coding System (HCPCS) coding, various jurisdictional fees schedule methodologies and expertise; and support dispute management
In-depth knowledge of state regulatory requirements
Good oral and written communication skills to effectively maintain customer service relations
Strong data entry skills needed for fast paced environment
Ability to independently and effectively manage issues such as complex processing/transaction issues, medical provider complaints, etc
Knowledge, skills and other capabilities normally acquired through a high school diploma (or equivalent), plus 1-2 years work-related experience
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://LMI.co/Benefits Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices
About the job
Apply for this position
Sr Medical Services Rep
Description
Review, analyze and process basic to complex medical bills for relatedness and appropriateness. (Complexity is based on dollar amount of bill and treatment received/coding used) Applies technical knowledge and judgment to make accurate, timely, and compliant payment decisions while meeting production requirements. Uses advanced data entry skills and multiple applications simultaneously.,
Responsibilities
Audit medical bills for relatedness and appropriateness for WC or Auto claims, using critical thinking skills to make accurate, timely, and compliant payment decisions while meeting production requirements Identifies and resolves discrepancies in transactions/documents reviewed. Refers difficult or questionable transactions to Supervisor for assistance in resolution. Maintains appropriate transaction records and generates activity reports. Provides guidance and assistance to internal customers, providers, claimants, and/or policyholders on inquiries and problems and explains processing procedures, etc. Maintains relationships with internal and/or external customers and providers to ensure timely processing of transactions. Responds to customer/provider inquiries and creates and issues provider correspondence. Communicates with claims professionals, attorneys, and others to gather necessary information in order to complete transactions.
Qualifications
Knowledge of medical terminology, medical coding
Intermediate to advanced knowledge of Current Procedural Terminology (CPT), International Classification of Disease (ICD), and Health Care Common Procedure Coding System (HCPCS) coding, various jurisdictional fees schedule methodologies and expertise; and support dispute management
In-depth knowledge of state regulatory requirements
Good oral and written communication skills to effectively maintain customer service relations
Strong data entry skills needed for fast paced environment
Ability to independently and effectively manage issues such as complex processing/transaction issues, medical provider complaints, etc
Knowledge, skills and other capabilities normally acquired through a high school diploma (or equivalent), plus 1-2 years work-related experience
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://LMI.co/Benefits Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices