OUR IDEAL CANDIDATE
As a Bill Review Specialist, you are responsible for applying WellRithms’ reimbursement methodology through medical bill review. This role calls for expertise in medical billing and CPT coding, as well as the ability to process medical bills accurately and efficiently. Experience in group health or workers’ compensation is a strong plus. You will develop a deep understanding of client workflows, reimbursement methodologies, regulatory requirements, and provider billing practices while serving as a key contributor to the accurate and consistent resolution of medical billing reviews and reconsideration requests. This position reports to the Bill Review Supervisor.

RESPONSIBILITIES

• Analyze medical bills and apply the WellRithms reimbursement methodology accurately and consistently.
• Perform a comprehensive review of medical bills, medical records, itemized statements, and supporting documentation to determine reasonable reimbursement.
• Review, process, and validate the correct use of CPT codes and other applicable medical billing standards.
• Investigate billing discrepancies, reimbursement disputes, and reconsideration requests by evaluating claim documentation and supporting evidence, and prepare clear, well-supported reimbursement determinations.
• Identify and correct billing, coding, or documentation errors while working within established workflows to complete medical reviews.
• Communicate with medical providers and other stakeholders to obtain additional information and facilitate claim resolution.
• Stay informed of industry trends, reimbursement guidelines, fee schedules, and regulatory changes impacting medical bill review and reimbursement practices.
• Meet established productivity and quality assurance expectations while managing a high-volume workload.
  Perform other duties as assigned.

QUALIFICATIONS

• High School diploma is required; some college is preferred.
• 2-3 years of experience in healthcare or a related field is preferred.
• Knowledge of CPT coding and medical terminology.
• Familiarity with HCFA1500 and UB-04 billing forms.
• Excellent written and oral communication skills.
• Ability to meet deadlines in a time-sensitive environment.
• High comfort level with computers and software programs (MS Word, Excel, Outlook).
• CPC (Certified Professional Coding) education or certification is preferred.