Billing Associate - Sedgwick Claims Management Services, Inc.
Orlando, FL
About the Job
Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.
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Billing Associate
PRIMARY PURPOSE: To review provider billing to ensuring appropriate healthcare common procedure coding (HCPC) / current procedural terminology (CPT) codes are applied. To ensure the accuracy and timely submission of client billing so that Sedgwick is paid correctly.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Reviews provider charges/bills per authorized amount/limit and in line with contracted rates and payment terms.
- Approves charges/bills for payment, then forwards them to the accounts payable team to issue payment and generates the explanation of review (EOR).
- Collects necessary information to resolve payment status inquiries.
- Assists with IT initiatives to improve processes and efficiency in a paperless environment.
- Acts as a liaison for accounts receivable and accounts payables.
- Resolves provider appeals.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
QUALIFICATIONS
Education & Licensing
High school diploma or GED required.
Experience
Two (2) years of workers compensation billing experience or equivalent combination of education and experience required.
Skills & Knowledge
- Basic understanding of revenue cycle management
- Knowledge of workers compensation state fee schedules
- Knowledge of ancillary healthcare network and provider contracts
- Understanding of HCPC/CPT codes and various forms such as DWC10, UB04 and HCFA
- Knowledge of various state by state billing regulations specific to workers compensation
- Ability to meet KPI metrics
- Excellent oral and written communication skills, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.