Medical Payments Processor II

Pinnacol Assurance does just one thing, and does it better than anyone: provide caring workers’ compensation protection to Colorado employers and employees. And while we may be a little biased, we believe that our work shapes communities and changes lives.

Review, validate, determine benefits payable in compliance with DOWC rules, and process medical and other bills submitted on CMS 1500 and UB04 forms, as well as, various other bill forms. 

• Review bills for services related to injury ensuring cost containment and customer service for company and policyholder
• Review all services to ensure billed charges are payable ensuring appropriate billing requirements are met
• Verify accuracy of workers compensation fee schedule and PPO discount to bill to ensure proper payment from Company
• Determine if additional bill review by other departments or other medical experts is needed; then release pending bills returned by departments or medical experts
• Answer bill and rule related questions via phone and email with other departments and providers when required
• Call provider for additional information in order to reduce re-bill requests
• Review previous processing of bill for consistent coding, accurate application of fee schedule and PPO processing criteria to ensure proper payment
• Enter paper medical bills timely and accurately
• Correct and re-issue erroneous payments when received

ADDITIONAL DUTIES:

• Perform other duties as assigned

• High School Degree or GED required.
• Completion of a degree is encouraged and supported.
• Six months in medical claims processing required.
• Medical terminology, CPT code, Colorado Workers’ Compensation rules are strongly preferred and knowledge may be substituted for experience.

WORK ENVIRONMENT / PHYSICAL ACTIVITIES:

• Regular business hours required. Extensive telephone and computer work in a home office environment.

Pinnacol is committed to working with and providing reasonable accommodations to applicants with disabilities. To request assistance with the application process, please email recruiting_team@pinnacol.com.

• Our benefits go beyond the basics. You’ll get to choose from diverse benefit offerings for medical, dental and vision.
• We care about each other. We enjoy a positive, collaborative work environment. We are hard workers and high performers.
• We love who you are. Pinnacol is on a journey to embody diversity, equity and inclusion. We’re committed to creating a culture that deeply values differences, where everyone feels like they belong.
• Take a day (or 20!) off. Enjoy 20 paid days off your first full year plus 9 paid holidays.
• Take care of yourself. Sign up for unique wellness programs, including on-site, company-paid fitness facilities and classes
• Get your learning on. We promote a learning culture to help you master your current job and cultivate the skills of the future through a variety of on-site, online, and off-site professional development opportunities.
• Give back and get paid. Through our employee volunteer program, Pinnacol in Action, employees receive paid time off to volunteer with Colorado nonprofits.
• Share in our success. You’ll have the opportunity to earn a quarterly incentive, up to 12 percent of your annual base salary, when your team exceeds their goals and objectives.