Bill Review Auditor
PMA Companies

York, Pennsylvania

Posted in Insurance

This job has expired.

Job Info

The Bill Review Auditor is responsible for activities involving the quality assurance of the bill review process for those services provided by PMA. Responsible to perform detailed audits for the bill review process.

Essential Functions:

  • Perform audits to evaluate service delivery for PMA Bill Review services.
  • Maintain current knowledge of jurisdictional requirements related to bill review.
  • Ensure compliance with business requirements, and adherence to all policy and procedure guidelines.
  • Identify trends, recommend corrective measures, and track results.
  • Develop and maintain training and resource modules. Provide education and training as necessary.
  • Provide feedback/recommendations to Supervisor, relevant to audit results to ensure effective operation and integration of business.
  • Assure all customers related inquiries relative to quality service are processed within specific guidelines/time frames.
  • Assure all customer specific audits are processed within specific guidelines/time frames.
  • Participates in special projects or perform other duties as required by Supervisor/Management.
  • Demonstrate commitment to Company's Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards, and laws applicable to job responsibilities in the performance of work.

  • Bachelor's degree or equivalent experience required.
  • 5 + years of medical bill review experience. Previous auditing experience is preferred
  • Working knowledge of state workers' compensation fee schedules, usual and customary databases, and payment regulations
  • Basic working knowledge of Microsoft office applications required; Conduent experience helpful
  • Knowledge of new medical and surgical procedures, drugs, medical products, and technology on the market
  • Familiarity with Medicare payment methodologies including the use of the National Correct Coding Initiative (NCCI) payment policies
  • Strong verbal and written communication skills with internal and external customers, vendors, and providers
  • Overall qualities: Strong initiative, team player, high energy, organizational skills, detail oriented, problem solving, and analytical skills.

This job has expired.

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