Xerox Bill Review Specialist I in Irvine, California

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Position: Bill Review Specialist

Department: Medical Bill Review

Reports to: Supervisor

Location: Irvine, CA, Lakeland, FL, or Work-From-Home

FLSA status: Non-Exempt

S/W Grade:

Incentive Comp:

Job Summary

The Bill Review Specialists is responsible for the audit of individual medical bills to ensure compliance with jurisdictional guidelines, state fee structures, as well as client specific guidelines.

Minimum Qualifications

  1. High school diploma/GED

  2. data entry skills

  3. ability to learn ICD-9 and CPT coding

  4. ability to use of Microsoft Windows-based software

  5. 10-key capabilities

  6. ability to learn and apply basic medical terminology

  7. basic computer skills

Preferred Qualifications

  1. One (1) or more years of experience in Medical Bill Review

  2. One (1) or more years of experience in Workers’ Compensation

  3. certificate of completion of medical coding and medical terminology program (technical center)

Primary Responsibilities

  1. Process HCFA, processional, facility, pharmacy, non-confirming bills to state guidelines

  2. Compares data entered with source documents, or re-enters data in verification format on screen to detect errors.

  3. Demonstrated mastery of processing rules

  4. Demonstrated understanding of bill review guidelines and procedures

  5. Accountability for assigned customer(s) results, productivity and quality

  6. Ensure authorization action is applied appropriately

  7. Compare qualifications of service provider with service rendered

  8. Maintains reference library of company and industry reimbursement policies.

Collateral Responsibilities

  1. Process all bills in a timely manner to meet client expectations

  2. May require one (1) year of demonstrated knowledge, skills and abilities in Validation and/or Link & Authorization as appropriate for assignment

  3. Demonstrate ability to manage time effectively and efficiently

  4. Responsibility for continuous learning and development of skills necessary to fully contribute to the organization

  5. Demonstrate the ability to work individually, as well as collectively, to address business challenges

Performance Expectations

  1. Minimum bill processing standards:

  2. 75% of production expectation by (60) days from hire

  3. Minimum processing rules mastery:

  4. Complete California certification, as required by Management

  5. Competency of (1) fee schedule jurisdiction within (30) days from hire

  6. Competency of fee schedule guidelines for all assigned states within (90) days from hire

  7. Maintain a monthly average of 98% bill accuracy rate by (90) days from hire

  8. Demonstrate understanding of bill review guidelines and procedures within (90) days of hire

Physical Demands and Work Environment

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical demands : prolonged sitting; use hands to finger or handle objects or controls; occasionally reach with hands and arms; occasionally lift and/or move up to 5 pounds; talk; hear; prolonged viewing of computer monitor.

Work environment : indoor office environment; minimal noise level.

Xerox is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, sex, marital status, sexual orientation, physical or mental disability, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply or compete for employment with Xerox may request such accommodation(s) by sending an e-mail to accommodations@xerox.com. Be sure to include your name, the job you are interested in, and the accommodation you are seeking.

Job: Service Delivery Healthcare

Organization: Workmans Comp Site

Title: Bill Review Specialist I

Location: California-Irvine

Requisition ID: 16027648

Virtual/work from home? No