Bill Review Representative

SFM Mutual Insurance Company - Bloomington, MN4.8

SFM - The Work Comp Experts. Work Somewhere You Love.

About SFM

Since 1983, SFM’s mission has been to be the workers’ compensation partner of choice for agents, employers, and their workers. While we’ve expanded to over 22,000 customers in the Midwest, and have grown our offerings to include vocational rehab, safe patient handling, loss prevention, medical services (and more!), our focus continues to be unrivaled customer service, injury prevention, and results.

The role

You will review a high volume of medical bills for reimbursement of services provided to injured workers and make payments in accordance with state appropriate workers’ compensation guidelines. Ensure production of high-quality, efficiency-driven and cost-effective bill review. Investigate billing practices of medical providers and participate in conferences to address payment rationale. Promote and maintain positive team relationships with internal and external customers and is involved in the Company’s and team’s cost containment plan.

Review medical bills in accordance with the appropriate state workers’ compensation guidelines and Company best practices, utilizing the Mitchell System and maintain a level of accuracy in accordance with Company standards and specific custom rules established by SFM.
Review bills timely and meet production and quality standards.
Partner with various vendors for professional bill review services as needed.
Perform necessary activities to obtain refunds of any overpayments as determined by management and contact providers if refunds are not received and documents the activity.
Report provider billing practices that are concerning such as potential for overutilization, fraud/abuse or patterns of repeated errors and assist in investigations and obtain guidance before issuing payment.
Respond timely to customer questions while applying the appropriate workers’ compensation rules.
Participate in conferences requested by the State and/or partner with defense counsel to provide rationale for payment decisions as well as Strategic Business Units, and communicate the reasons of action to the appropriate party involved with the claim.
Adheres to standards for Company and best practices and agreements made under the Partnership Agreement with the Strategic Business Units and other teams.

We’re looking for:
Associate’s degree in business or nursing, or similar field; in lieu of an associate’s degree, two or more years of technical training in a medical coding or medical billing insurance environment is acceptable.
Knowledge of workers’ compensation insurance and or medical coding experience preferred.
Certified Professional Coder (CPC), Licensed Practical Nurse (LPN) or other medical-related certification or designation is highly desirable.
Experience in Mitchell Software is a plus.
Ability to understand and use analytical skills relating to business interpretation of medical documents, including CPT, ICD, HCPS, CMS and bundling.
Strong oral, and written communication skills.
Excellent organizational skills and detailed oriented.
Ability to work in a fast-paced environment.
Basic math skills.
Ability to maintain confidentiality.
Excellent customer service skills, and the ability to work well within a team environment.

Physical Requirements:
Work takes place in a paperless environment within an office, using a standard office equipment such as computers, phones, photocopies, which requires being stationary for extended periods of time. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions..

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

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SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify. Applicants have rights under Federal Employment Laws.