Job duties for this position center on the ability to provide payment recommendations for the billings from medical providers for medically related services delivered to worker’s injured on the job.
- Confirm claimant and health care provider information
- Confirm diagnosis between medical bills and claims data
- Confirm and apply utilization review authorization/denial when applicable
- Utilize and interpret supporting documentation attached to medical billings from providers (reports, etc.)
- Determine reasonable reimbursement by application of OMFS rules, regulations and guidelines
- BS / BA or Equivalent Work Experience
- Strong comprehension and analytical skills
- Ability to multi-task – based on the review types
- Ability to think outside the box
- Official Medical Fee Schedule
- CPT Codes (Current Procedural Terminology)
- Medical Terminology
York Risk Services Group is a premier provider of a full range of insurance, risk management, pool administration, claims management, and...