AvonRisk is a specialty risk manager serving self-insured organizations across workers' compensation, liability, managed care, and risk management. This role processes and audits medical bills under workers' compensation fee schedules, ensuring accurate reimbursement and compliance with company production standards.
Essential duties
- Code medical bills into the company system with speed and accuracy.
- Perform preliminary screening for appropriateness and medical necessity of services rendered.
- Use CPT and ICD-9/ICD-10 codes, fee schedules, and related resources to determine reimbursement.
- Flag problem bills to the Bill Review supervisor.
- Communicate with clients and providers to clarify information.
- Forward unidentifiable or unlisted procedure numbers for review.
- Price hospital and surgery bills to applicable fee schedules.
- Process reconsideration requests as assigned.
- May specialize in state-specific or client-specific responsibilities.
- May assist with provider calls.
Requirements & Qualifications
Required experience and education
- High school diploma or GED.
- Minimum of 1 year of data entry or medical billing experience.
- Additional 2 years of bill review experience in a workers' compensation environment.
Required knowledge and skills
- Strong knowledge of CPT and ICD-9/ICD-10 coding.
- Knowledge of workers' compensation fee schedules and regulations.
- Familiarity with company software systems and workflow processes.
- Strong attention to detail and accuracy.
- Effective oral and written communication skills.
- Ability to work independently under limited supervision and meet production quotas.
- Basic math skills, including rate, ratio, percent, and graph interpretation.
- Proficiency with word processing, spreadsheets, and database software.
Certification
- Medical Bill Reviewer Designation required, including 40-hour initial certification and 16 continuing education hours every 2 years.
Benefits & Perks
Benefits
- Medical, dental, and vision insurance
- HSA and FSA company contributions
- Employer-paid life and disability insurance
- 401(k) with company match
- Paid time off and company holidays
- Learning and development opportunities
- Employee assistance resources
- Supportive, balance-focused culture
Location
California, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 week ago