Medical Fee Examiner
Core
Review and process medical service bills for workers' compensation claims, apply the Medical Fee Schedule, and administer informal fee dispute procedures.
Role type
Medical Fee Examiner (IC)
Builds
Repriced medical bills and dispute resolution summaries for workers' compensation claims
Domain
Public sector / Workers' Compensation / Healthcare Administration
Required skills
Medical terminology, clinical and surgical procedures, medical coding, Medicare reimbursement methodologies, data entry, business correspondence drafting, regulatory compliance review, multi-tasking
Preferred skills
Experience in hospital, clinic, insurance company, or private organization determining medical charges
Technologies
None stated
Responsibilities
Reprice medical bills upon request or advise parties via telephone/email; Update and maintain the Medical Fee Schedule annually; Issue letters regarding medical bill issues; Advise on medical bill processing or coding issues; Administer the informal phase of the Health Care Provider Fee Dispute Procedure; Maintain statistics on unit work
Seniority
Mid-level, individual contributor