Quality Assurance Reviewer - Worker's Comp
Review invoices to determine if charges are reasonable, appropriate, and within the customer’s billing guidelines.
Examine reports for proper medical case management documentation and completeness Generate finalized QA invoice and support to be sent to the customer.
Analyze audit reductions timely and request refunds on disputed invoices.
Respond to communication from the field offices regarding reporting issues or billing
questions. Provide constructive feedback on areas needing improvement.
Evaluate and resolve pending reports and invoices. Follow up with field office on items sitting
in a “draft” status for more than a week.
Participate in monthly QA team meetings and provide update on quality issues to QA
Ability to stay focused on task completion in high volume environment.
5 years of work experience in the healthcare or insurance field, workers compensation and medical case management background preferred
Ability to review, interpret and process large amounts of information efficiently with strong attention to detail
Ability to work independently using analytical skills and good business judgment
Intermediate to advanced skills in Access, Excel and Word applications
Proficient in use of computers (dual monitors and mouse)
Excellent typing and alpha/numeric data entry skills (10-key and typing by touch)