Workers Compensation, Medical Bill Review, Operations Analyst

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Job Description:

  • Serve as a subject-matter expert for Medical Bill Review (MBR) operations;
  • Provide advanced production support and drive process improvements;
  • Coordinate cross-functional issue resolution and project execution;
  • Support processing of workers’ compensation medical and pharmacy bills from bill intake through payment;
  • Investigate bill processing issues and problem-solve;
  • Interface with multiple vendors for issue resolution;
  • Monitor business dashboards and vendor reports daily for TAT trends;
  • Recommend workflow enhancements and document trends and issues for improvement;
  • Build and maintain relationships with internal teams, external vendors, and medical providers.

Requirements:

  • MBR business process SME including experience with MBR E2E process from a business/operations perspective;
  • firm understanding of integrated services and workflows including FS/UCR, Nurse and code review, PPO, negotiations, adjustor bill adjudication;
  • workers compensation regulatory environment experience/understanding;
  • Demonstrated application of successful critical thinking and complex problem solving skills;
  • Experience in a role requiring deep understanding of and experience working with MBR and integrated services technology;
  • Experience gathering business requirements and clearly documenting complex scenarios and use cases;
  • Communication experience with varied audiences including leadership and peers in business/operational & technology roles;
  • Client-facing acumen;
  • Team-player;
  • Experience with Atlassian/JIRA/SQL.
  • 5 years in a multi-faceted workers compensation MBR role demonstrating increasing responsibility with required skills outlined above within that time or 3 years in an MBR role + 2 years in position with similar responsibilities.

Benefits:

  • Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
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