United States (Remote)
Job Description
To efficiently and accurately audit bills according to standard Broadspire, State and/or National legislative and fee guidelines.
Responsibilities
- Review and verify diagnosis codes, provider information, payer information, procedure codes and dates of service.
- Identify bills requiring research and assign bill notes and/or explanation codes indicating the reason for additional research. Apply bill/form type, modifiers and units when necessary. Process duplicate bills according to standard procedures.
- Enter bill information manually when required, calculating appropriate payment recommendation if necessary. Transfer bills that meet specific criteria; (i.e., surgical, ambulatory, etc). May consult with internal medical professionals to receive support for bill decisions to reduce legal exposure.
- Review and interpret relevant medical information including medical records, treatment reports, operative reports, consultation reports, diagnostic evaluations and functional capacity evaluations to accurately determine adjudication.
- Verify fee schedule and usual and customary rules according to state law or national guidelines. Apply advanced and/or proprietary reimbursement methodologies when appropriate.
- Communicate with providers, trainers and peers verbally and in written form.
- Meet required Quality/Production Standards while maintaining turnaround on assigned states. Ensure accurate and efficient processing; accurately report bills processed daily.
- May perform other duties as assigned.
Qualifications
- A high school diploma or equivalent experience is required.
- 2 or more years work experience with CPT and ICD-9 codes or classroom experience is required.
- ility to problem solve, analyze, organize and prioritize work. Strong reading comprehension, verbal and written communication skills required with Windows environment experience. Must be able to produce a high volume of quality work, be organized, multi-tasked, and prioritize work. Familiar with HFCA and UB92 forms is required.
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About Us
Why Crawford?
Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time.
At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us.
We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com.
When you accept a job with Crawford, you become a part of the One Crawford family.
Our total compensation plans provide each of our employees with far more than just a great salary
- Pay and incentive plans that recognize performance excellence
- Benefit programs that empower financial, physical, and mental wellness
- Training programs that promote continuous learning and career progression while enhancing job performance
- Sustainability programs that give back to the communities in which we live and work
- A culture of respect, collaboration, entrepreneurial spirit and inclusion
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.
