Bill Review Complex Analyst, Risk Management - Lakeland

Bill Review Complex Analyst, Risk Management - Lakeland | Publix Super Markets, Inc.

The purpose of this position is to analyze and review medical bills for adjudication of invoices for Publix associates injured in Workers Compensation accidents. The Bill Review Analyst is responsible for ensuring bills are paid in a timely manner and in accordance with the Workers Compensation laws of the states in which Publix does business in. Primary Responsibilities:

• This position is responsible for reviewing and analyzing medical bills to confirm whether treatment rendered was authorized by the adjuster or medical case manager is appropriate for the type of injury sustained, and that the fees invoiced are standard and equitable, follow appropriate schedules and regulations, and align with previous contracted agreements.
• This position is responsible for manually reviewing and resolving issues on medical bills that are flagged as requiring more in-depth review, or which cannot otherwise be re-priced to the appropriate state workers' compensation fee schedule by our automated medical bill review system (Smart Advisor).
• This position is responsible for communicating directly with vendors and medical providers that challenge the amount reimbursed. Disputes regarding medical billings are administered in accordance with the appropriate state mandated "Reconsideration Process," as required by each individual state's workers' compensation rules and regulations, which contains stringent timelines. These challenges are typically received via telephone, fax, or in writing.
• This position is responsible for provide customer service activities to providers, Publix managers, and associates that contact Risk Management regarding the payment or non-payment of bills.

Required Qualifications

• Associate's degree
• 1-year general office with experience with Windows based programs
• National Certification for CPT Coding
• Knowledge of CPT and ICD-9 codes
• Knowledge of multiple state Worker's Compensation Fee Schedules for the states in which Publix does business in
• Knowledge of Medical Terminology
• Initiative
• Planning and Organizing
• Stress-Tolerance
• Time Management
• Financial Acumen
• Detail Orientation
• Problem Solving
• Building Relationships
• Customer Focus
• Verbal Communication
• Written Communication
• Microsoft Word (Basic)
• Microsoft Excel (Basic)
• Microsoft PowerPoint (Basic)
• Microsoft Access (Basic)
• Availability to work weekends (rare)
• Availability to work holidays (occasional)
• Availability to work extended hours (occasional)

Preferred Qualifications

• BS degree or certificate of completion of a medical terminology or medical billing program
• 1 year in medical or insurance services, with advanced knowledge of CPT and ICD-9 codes, and knowledge of medical terminology
• National Certification for CPT Coding
• Bilingual in English and Spanish
• Microsoft Word (Expert)
• Microsoft Excel (Advanced)
• Microsoft PowerPoint (Intermediate)
• Microsoft Access (Advanced)
• SmartAdvisor/CEPV
• ODG
• Mitchell and RMX software systems, or similar bill review software

Hours of Work

Monday - Friday, 8:00am - 4:30pm

Frequency of Pay

Weekly

Minimum Base Pay

20.05

Maximum Base Pay

27.65

Potential Annual Base Pay

41,704 - 57,512

Year End Bonus

To reward associates for their contributions to the company for the calendar year, Publix provides a Holiday Bonus in November. In the first year of continuous employment the bonus is equal to 15 hours of pay, and in the second year of continuous employment the bonus is equal to one week's pay if associate remains employed through issue date of the bonus check. In subsequent years, the bonus is equal to two weeks' pay.

Benefits Information

• Employee stock ownership plan that contributes Publix stock to associates each year at no cost
• An opportunity to purchase additional shares of our privately-held stock
• 401(k) retirement savings plan
• Group health, dental and vision plans
• Paid Time Off
• Paid Parental Leave
• Short- and long-term disability insurance
• Tuition reimbursement
• Free hot lunches (buffet-style) at facilities with a cafeteria
• Visit our website to see all of our benefits: Benefits - Jobs (publix.com)