Description

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.

This position requires an individual experienced in Medical Bill Review who, under minimal supervision, can independently analyze all incoming medical bills for usual and customary or fee schedule application, including re-evaluations, multi-state and multi-line of business medical bills, while meeting contracted client requirements. This individual needs to have strong written and communication skills to be able to handle provider disputes. Properly operates computers (hardware and software), while maintaining an acceptable speed and level of accuracy determined by company standards and Department manager.

Responsibilities:

• Enter and independently review professional services from client submitted medical bills in bill review system covering:
  • Medical bills in Smartadvisor
  • Analysis on all U & C exposures
  • Analysis for 6+ assigned states having fee schedules
  • Multi-state Jurisdiction
  • Multi-Line Business
  • Provider file maintenance
  • Claim file maintenance
  • Handle Re-evaluation disputes with providers
• Independent research on usual and customary/fee schedule application and system interface.
• Interface in training co-workers.
• Provide Quality Review as assigned by Lead/Supervisor.
• Provide feedback type training in quality assurance of work product from co-workers.
• All other duties as assigned by the Lead/Supervisor.

• Must be CPC certified
• Complete knowledge of CPT/ICD-10/HCPCS/NDS codes.
• U&C bill review experience (6-9 months).
• Fee scheduling bill review experience (9-12) months.
• Multi-jurisdictional bill review experience (6+ fee schedule states).
• PPO re-pricing (6-9) months.
• H.S. Diploma or equivalent.
• 10-key by touch.
• Strong written and communication skills.
• Knowledge of:
  • CPT/ICD-10/HCPCS/NDS codes.
  • Knowledge of usual and customary bill review application.
  • Knowledge of fee scheduling bill review application.
  • Multi-jurisdictional bill review experience (3+ fee schedule states).

PI278910846