Job Description

Purpose: Responsible for accurately applying PPO guidelines to medical bills in accordance with department policies and procedures.

Essential Job Functions:

Determine provider participation status when automated matching is inconclusive.
Apply PPO guidelines accurately to bills requiring manual intervention.
Communicate effectively with clients and internal teams via email or phone to request necessary bill documentation and resolve discrepancies.
Collaborate with the PPO Application team to address bill-specific inquiries and policy questions.
Utilize software tools to calculate contracted rates, including AWP, Medicare, and state/federal fee schedules.
Support Senior PPO Application Specialist in quality assurance processes as needed.
Education: High School Diploma Required

Required Experience and Skills:

Familiarity with medical billing processes, including CPT Codes, Revenue Codes, ICD-9/ICD-10 Codes, and PPO guidelines.
Proficiency in Windows-based software/applications.
Strong typing accuracy.
Ability to review documentation and apply departmental policies.
Team-oriented with a proactive work ethic.
Motivated self-starter.
Equal Employment Opportunity Statement:

We provide equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour

Job Tags

Hourly pay, Full time, Local area, Remote job,

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