Medical Bill Review & Compliance Advisor

Medical Bill Review & Compliance Advisor

This Medical Bill Review & Compliance Advisor (MBR) role is responsible for the management of the vendors related to the medical bill review process as well as PPO network performance results. Performs analysis of trends to identify appropriate solutions and responses to positively impact loss costs and expense savings. Ensures adherence to compliance regulations by monitoring and providing oversight to all rules and regulations. Provide operational consistency and integrity as well as continuous quality improvement and maximum performance. Serve as a technical expert with regards to workers compensation medical spend strategy focused on enterprise bill review processes.

Responsibilities / Tasks :

• Assists Sr. MBR in the development and distribution of reports around medical spend, operational performance and efficiencies, for marketing, new / renewing policies, and regulatory compliance.
• Constructs and prepares reports for Medical Bill Review leadership comparing results to established benchmarks and recommends process changes, as appropriate.
• Supports Sr. MBR in the management of enterprise medical bill review vendors and vendors associated with the medical cost containment programs.
• Monitors PPO / network vendor activity including compliance with contractual requirements, outcomes, savings, and penetration rates.
• Assists medical bill managers with implementation and monitoring of policies, practices, and procedures.
• Responds to special or specific audit and / or research requests.
• Performs special projects, as assigned.
• Maintains confidentiality of all information processed.

Employment Qualifications :

Education or Equivalent Experience : Bachelor's degree in insurance, business, or a related field. Combinations of relevant education and experience may be considered in lieu of a degree, preference given to degree. Continuous learning required, as defined by the Company's learning philosophy.

Experience :

Skills / Knowledge / Abilities (SKA) Required :

Working Conditions :

Work is performed in an office environment with minimal hazards. Travel will be required.

Pay Range : Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic.