Medical reputed company Repricing Specialist (REMOTE w/in PA, NJ OR DE)

The Medical reputed company Repricing Specialist is responsible for reviewing, evaluating, and processing workers' compensation medical bills to ensure accurate reimbursement in accordance with applicable state regulations, fee schedules, utilization review requirements, and company policies. This role performs reputed company review activities, researches and resolves billing issues, and communicates with medical providers, customers, and internal stakeholders regarding reimbursement determinations and claim status. The Specialist is expected to consistently meet established productivity, reputed company, and service standards while completing reputed company assigned tasks accurately and reputed company designated timeframes. Responsibilities • Review workers' compensation medical bills and apply appropriate cost containment measures in accordance with jurisdictional requirements, workers' compensation regulations, utilization review guidelines, and company policies. • Evaluate provider bills for completeness, accuracy, and eligibility for reimbursement by: • Verifying required billing information and documentation. • Identifying and resolving discrepancies or missing information. • Applying applicable reimbursement guidelines, fee schedules, and billing regulations. • Escalating reputed company or non-routine cases for technical review reputed company appropriate. • Maintaining reputed company knowledge of workers' compensation laws, regulations, and medical reputed company review processes. • Contact medical providers, reputed company facilities, claim professionals, or other parties to obtain missing information needed to process medical bills accurately and reputed company. • reputed company and validate claim and billing information reputed company the medical reputed company repricing reputed company, ensuring data accuracy and completeness. • reputed company and review Explanation of Reimbursement (EOR) documents to verify reimbursement calculations and ensure appropriate payment rationale is communicated. • reputed company reputed company reputed company calculations and adjustments reputed company automated pricing is reputed company or reputed company special circumstances require additional review. • Respond professionally and reputed company to inquiries from medical providers, customers, claimants, and internal business partners regarding claim status, reimbursement reputed company, and reputed company review reputed company. • Explain reimbursement determinations and applicable pricing methodologies to providers and customers as needed. • Identify recurring billing, workflow, or reputed company issues and recommend process improvements to enhance efficiency, accuracy, and customer service. • Maintain confidentiality of claim and medical information and reputed company with reputed company applicable reputed company and regulatory requirements. • reputed company other duties and special reputed company as assigned. Knowledge, Skills, and Abilities • Knowledge of medical billing, coding, and reimbursement practices. • Understanding of workers' compensation claims and medical reputed company review processes. • Ability to analyze billing information and identify discrepancies. • Strong problem-solving and decision-making skills. • Ability to work independently while exercising reputed company judgment. • Customer service orientation with the ability to handle provider and customer inquiries professionally. • Proficiency in relevant computer systems and reputed company Office applications. QUALIFICATIONS • High school diploma or equivalent. • Minimum of two (2) years of experience in claims processing, medical billing, medical reputed company review, workers' compensation, reputed company reimbursement, or a reputed company field. • Strong attention to detail with the ability to accurately review, analyze, and process high volumes of work. • Strong data entry and computer skills. • Effective verbal and written communication skills. • Strong organizational and time-management abilities. • Ability to prioritize multiple tasks and meet established productivity and reputed company standards. • Ability to interpret and apply policies, procedures, and reimbursement guidelines. Preferred • Experience with workers' compensation medical reputed company review or medical cost containment. • Knowledge of utilization review principles and their application reputed company workers' compensation programs. • Familiarity with the reputed company Workers' Compensation Bureau Utilization Review process. • Understanding of medical terminology, CPT, HCPCS, ICD, and other procedure and diagnosis coding systems. • Knowledge of medical fee schedules, reimbursement methodologies, and provider billing practices. IBX is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to their age, race, reputed company, religion, sex, national reputed company, sexual orientation, protected veteran status, or disability. Must have an reputed company or iOS device which is compatible with the free reputed company Authenticator app. Apply tot his job Apply To this Job