Medical Bill Reviewer-100% remote (Anywhere in US)

Position Overview

Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, skilled staff, premier health care provider networks, and our commitment to client needs. As a MEDICAL BILL REVIEWER working 100% REMOTE (Anywhere in US), you will be responsible for handling manual processes involved in accurately applying PPO guidelines to medical bills in a timely manner.

Key Responsibilities

• Identify a provider as participating or non-participating when the automated matching process is unable to make that determination.
• Accurately apply PPO guidelines to bills when a participation match has been made but the automated re-pricing process cannot apply the guidelines.
• Communicate with clients and internal Bill Review staff via e‑mail or phone to request bill images or documentation, and to question keying errors or discrepancies requiring corrections.
• Coordinate with the PPO Application team regarding questions and concerns about specific bills or general policies and procedures.
• Utilize appropriate software and documentation to calculate contracted rates, including AWP, Medicare, or applicable state or federal-mandated fee schedules.
• Assist the Senior PPO Application Specialist with the QA process when necessary.

Required Qualifications

• Education: High School Diploma Required
• Experience with medical bill processes, including familiarity with CPT Codes, Revenue Codes, Bill Types, ICD-9/ICD-10 Codes, State Fee Schedules, UCR, and PPO.
• Experience working with Windows-based software/applications.
• Ability to type accurately.
• Ability to review documentation and make decisions based on department policies and procedures.
• Strong teamwork skills and a motivation to be a self-starter.

EEOC Statement

Medlogix provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.