Highmark Health
Montpelier, VT, USA
**Company :** Highmark Inc. **Job Description :** **JOB SUMMARY** This job is responsible for educating providers on proper billing behavior and proper usage of procedure codes and/or modifiers who are identified as outliers in regards to billing Highmark for certain targeted codes; outreach may occur in various formats including written letters, emails, and consultations via telephone. Documents explanations from Provider Outliers to be used in the analysis of billing behavior and cost savings. **ESSENTIAL RESPONSIBILITIES** + Performs outreach via telephone or other means to identified Outlier Providers informing them of their inclusion as an Outlier; meaningfully discusses the Outlier Providers' billing practices and provides education on proper usage of procedure codes and/or modifiers. May also field incoming calls from providers. + Applies medical coding knowledge to determine applicable education for Outlier Providers on industry standards and guidelines as...