Job details
Job type full-time
Full job description
About conduent: through our dedicated associates, conduent delivers mission-critical services and solutions on behalf of fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on themYou have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every dayJob description: job summary
The bill review quality assurance auditor is responsible for the audit of individual medical bills to ensure compliance with jurisdictional guidelines, state fee structures, as well as client specific guidelines.
Minimum qualifications
High school diploma/ged
Data entry skills
Ability to learn icd-9 and cpt coding
Ability to use of microsoft windows-based software
10-key capabilities
Ability to learn and apply basic medical terminology
Basic computer skills
Must be 18 years or older
Must be able to pass a background and drug test
Preferred qualifications
One (1) or more years of experience in medical bill review
One (1) or more years of experience in workers’ compensation
Certificate of completion of medical coding and medical terminology program (technical center)
Primary responsibilities
Process and audit hcfa, processional, facility, pharmacy, non-confirming bills to state guidelines
Compares data entered with source documents, or re-enters data in verification format on screen to detect errors.
Demonstrated mastery of processing rules
Demonstrated understanding of bill review guidelines and procedures
Accountability for assigned customer(s) results, productivity and quality
Ensure authorization action is applied appropriately
Compare qualifications of service provider with service rendered
Maintains reference library of company and industry reimbursement policies.
Collateral responsibilities
Process all bills in a timely manner to meet client expectations
May require one (1) year of demonstrated knowledge, skills and abilities in validation and/or link & authorization as appropriate for assignment
Demonstrate ability to manage time effectively and efficiently
Responsibility for continuous learning and development of skills necessary to fully contribute to the organization
Demonstrate the ability to work individually, as well as collectively, to address business challenges
Performance expectations
Minimum bill processing standards:
100% of production expectation by (90) days from hire
Minimum processing rules mastery:
Complete california certification, as required by management
Competency of (1) fee schedule jurisdiction within (90) days from hire
Competency of fee schedule guidelines for all assigned states within (90) days from hire
Maintain a monthly average of 98% bill accuracy rate by (90) days from hire
Demonstrate understanding of bill review guidelines and procedures within (90) days of hire
Physical demands and work environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this jobReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: prolonged sitting; use hands to finger or handle objects or controls; occasionally reach with hands and arms; occasionally lift and/or move up to 5 pounds; talk; hear; prolonged viewing of computer monitorWork environment: indoor office environment; minimal noise level.
Closing: conduent is an equal opportunity employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.
People with disabilities who need a reasonable accommodation to apply for or compete for employment with conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the `submit` button at the bottom of the formFor those using google chrome or mozilla firefox please download the form first: click here to access or download the formYou may also click here to access conduent’s adaaa accommodation policy.
