The Medical Service Representative (MSR) reviews and analyzes basic to medium complexity medical bills (based on dollar amount of bill and treatment received/coding used) for relatedness and appropriateness for Claims, uses critical thinking skills to make accurate, timely, and compliant payment decisions while meeting department standards. The MSR will work within multiple applications simultaneously with strong keyboarding abilities.
Responsibilities include:
Audit medical bills for relatedness and appropriateness for Claims, using critical thinking skills to make accurate, timely, and compliant payment decisions while meeting production requirements.
Identifies and resolves discrepancies in transactions/documents reviewed. Refers difficult or questionable transactions to Supervisor for assistance in resolution. Maintains relationships with internal/external customers and providers to ensure timely processing of transactions.
Provides guidance and assistance on inquiries and problems and explain processing procedures, etc.
Issues provider correspondence.
Communicate with case managers, attorneys, and others to gather necessary information in order to complete transactions.
Perform limited office support functions as assigned.
Job Specifications:
Reference: 2022-48492
Category: Claims
Primary Location: Remote
Additional Locations:
Schedule: Full-TimeSalary: USD-$37,501.00-–-$45,900.00-/-Year
Education Level: High School Diploma/GED
Travel: As Needed