Nexus

Full-time Description The remote Coder/Specialty Medical Bill Reviewer is responsible for reviewing, auditing, and data entry of medical bills for multiple states and lines of business within both Worker’s Compensation and Commercial Health arenas. This would include analysis for the fee schedule or usual and customary application, as well as PPO interface, while meeting contractual client requirements. Essential Job Functions: Responsible for auditing medical bills to ensure that they are appropriate and adhere to the State Fee Schedules, customer guidelines, and PPO discounts Analysis and review of 1 or more assigned states having fee schedules Utilize Fee Schedules, Online Documents, Client instructions, and other training material to properly review medical bills Review medical bills for compensability and relatedness to injury Reprice medical bills to Workers’ Compensation Fee Schedule and PPO Network Research usual and customary/fee schedule applications and system...

A leading healthcare provider seeks a skilled Coder/Specialty Medical Bill Reviewer to work remotely. The ideal candidate will have expertise in reviewing and auditing medical bills across various states, ensuring compliance with fee schedules and client guidelines. Responsibilities include analyzing medical billing, repricing bills, and communicating methodologies for reductions. Candidates must possess an AAPC Coding Certification and have a strong background in medical terminology and coding practices. This is a full-time position based in Texas with opportunities for meaningful contribution in a collaborative environment. #J-18808-Ljbffr