Medical Bill Reviewer - Eastern Alliance at Proassurance in Lancaster, Pennsylvania

Job Description:

An exciting opportunity exists to join the ProAssurance family of companies!




We are a specialty writer of professional liability, products liability and workers' compensation insurance. With approximately 1,000 team members operating in all 50 states, we are well-positioned to offer career opportunities to individuals interested in professional growth.



This position supports our workers' compensation line of business, Eastern Alliance and will report to our Lancaster PA office daily for initial training, then will report to the office once a week.


The ideal candidate will enjoy reviewing medical bills, take pride in providing exceptional customer service, thrive in a team environment, and possess basic medical terminology or ICD-10 code knowledge.


Internally the job title for this position is Medical Bill Specialist.


ProAssurance supports its team members in obtaining and maintaining position-related certifications.



Job Summary:



The primary responsibility of the Medical Bill Specialist is to consistently execute the Company's ecovery® Return to Wellness philosophy and business model that leads to better outcomes for our injured workers and insureds. The primary responsibility of this position is timely and accurate processing of medical bills in order to deliver superior levels of customer service, maximize savings and ensure compliance with regulatory requirements in support of the Company's revenue and profitability objectives and overall business plan.



Essential Functions:

• 75% - Process medical bill information received from StrataWare Hold Report, Capture+, and/or Vendor Que; verify accuracy of information on the form including units, providers, account numbers, tax id's and dates of service, release accurate bills from to PPO vendor, and approve or deny any unassigned bills returned from PPO vendor.


• 10% - Review all bills for compliance with state fee schedules according to regulatory requirements and procedures; re-price according to state guidelines when needed.


• 10% - Respond to telephone inquiries from agents, customers, injured workers and providers in a professional, courteous and timely manner, providing high levels of customer service at all times.

• 5% - Prepare and print form letters as necessary to request additional information according to company procedures and print checks in specified accounts, as a backup function.

• High School diploma or GED is required plus a minimum of 3 years of experience in a medical office, claims or similar environment is required.


• Certification in medical billing and coding preferred.


• Basic knowledge of medical terminology and/or ICD-10 codes is required.


• Proficiency in Microsoft Office computer applications, including Word & Excel, and ability to learn new software.


• Attention to attend to in processing payments and entering data, establishing priorities and meeting deadlines.


• Ability to handle multiple priorities simultaneously.


• Excellent organization and time management skills.


• Ability to assess the urgency and importance of a situation and take appropriate action.


• Empathic listener with the ability to listen and respond to another person in a way that engenders mutual understanding and trust.


• Ability to communicate effectively and professional both verbally and in writing with various constituencies and at all levels, both in and outside of the organization, including agency partners, customers, injured employees and providers.


• Ability to maintain confidential information.


• Ability to operate standard office equipment including, but not limited to copiers, printers, etc.