Medical Bill Adjuster

The above represents the full salary range for this job requisition. Ultimately, in determining your pay and job title, we'll consider your location, education, experience, and other job-related factors, and will fall within the stated range. Your recruiter can share more information about the specific salary range during the hiring process.

If you know a current Encova Insurance associate and would like to apply as a referral, please encourage them to submit your referral information before you submit your application. You will receive an email with a direct URL link to the Job Posting of interest. Applying through this URL link will create your referral relationship for our Talent Acquisition Team.

Encova is only able to employ associates who reside and work within specific U.S. states. Our current policies are based on the laws in states in which we are registered for payroll. Our current footprint includes:

Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, Wisconsin.

JOB OBJECTIVE:

The Medical Bill Adjuster researches, audits and processes moderately complex to complex medical bills for payment. This position determines the appropriateness of procedural coding, diagnosis and services that require prior approval. The Medical Bill Adjuster processes bills for all locations in which Encova Insurance conducts business.

ESSENTIAL FUNCTIONS:

1. Process medical invoices based on a pre-determined quota.

2. Ensure bills are related to compensable injury.

3. Research medical records to determine appropriate coding.

4. Audit and process inpatient hospital bills.

5. Audit and process higher-dollar claims.

6. Audit high-level evaluation and management bills for appropriate billing.

7. Review invoices for correct coding and correct usage of modifiers.

8. Approve additional units for payment for certain CPT/HCPCS codes.

9. Discuss billing matters with medical providers, claims adjuster, and customers.

10. Identify vendor trends and training needs and make recommendations accordingly.

11. Prepare reports and compile comprehensive data relating to the vendor review unit.

12. Analyze and manipulate report data.

13. Consult as needed with other staff regarding training needs.

14. Perform system testing as needed.

OTHER FUNCTIONS:

1. Nonessential functions: other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

•    Associate or bachelor’s degree from an accredited college or university is strongly preferred; commensurate experience may be considered.
•    A minimum of three years of experience in medical coding or medical bill processing is required.
•    Certification in medical coding from either AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association) is strongly preferred.
•    Strong attention to detail.
•    Extensive knowledge of medical billing, ICD-10, CPT-4, DRG and HCPCS coding.
•    Comprehensive understanding of medical invoices and forms.
•    Effective computer skills.
•    Ability to effectively prioritize and carry out work assignments.
•    Strong computer skills.
•    Strong communication skills.
•    Ability to use and apply basic math skills.
•    Understanding of Preferred Provider Organization (PPO).
•    Extensive knowledge of medical terminology.
•    Excellent data entry skills.
 

This position has been evaluated in accordance with the Americans with Disabilities Act.  Encova Insurance makes every effort to reasonably accommodate disabilities to permit performance of the essential functions and candidates who need such accommodation are encouraged to seek it.  This description reflects the nature and level of work performed by associates in this position.  It is not an all-inclusive inventory of duties, responsibilities and qualifications required.  It provides an accurate overview of the work and skills needed to perform this position.  Because job content may change from time to time, Encova Insurance reserves the right to add and/or delete functions from this job as it deems necessary for business reasons.

In addition to a competitive compensation package, we offer a comprehensive benefits package designed to support the well-being and growth of our associates. Available benefits (subject to any policy or plan changes) include, but are not limited to:

• Health, Dental & Vision Insurance

• Company-provided life and income protection plans

• Eligibility to participate in a company incentive bonus program

• 401(k) Retirement Plan - 100% company match up to 7% on annual salary

• Paid Time Off, Paid Holidays, and Floating Holidays

• Flexible Work Arrangements - Hybrid and remote depending on the role

We believe that happy, healthy associates are the foundation of great work. Join us and thrive both professionally and personally.

Encova Insurance is an EOE/E-Verify employer.