Medical Bill Coder Representative

3 weeks ago

Bloomington, United States SFM Mutual Insurance Companies Full time
Medical Bill Coder Support Representative

SFM - The Work Comp Experts

Work somewhere you love

SFM is unique in that we are small enough that your voice is heard but has all the benefits and perks of a larger employer. We value your opinion, help you reach your goals, and make it easy for you to maintain work-life balance. SFM is committed to creating the best work environment and believes that our exceptional and motivated employees are our greatest strength. SFM emphasizes work life balance, and our benefit package is designed to assist you navigate your work-life journey.

Our benefits include:
  • Affordable Medical, Dental, Vision Insurance, HSA, FSA
  • Flexible hybrid work environment
  • Traditional and Roth 401(k) plans with company match
  • Company contributions to help pay off student loans
  • Monthly home internet allowance
  • Free life insurance, STD & LTD
  • Opportunities for annual gainshare bonus
  • Pet insurance
  • Generous PTO
  • 9 paid holidays
  • Paid parental leave
  • Annual company-wide volunteer day
  • Discounts on gym memberships, fitness apps and weight loss programs
  • Adoption financial assistance

Visit our careers page to learn more about working at SFM

About SFM

Since 1983, our mission has been to be the workers' compensation partner of choice for agents, employers and their workers. SFM seeks to inspire safer workplaces by protecting workers from harm and helping the injured recover. We have expanded to well over 25,000 customers in the Midwest and grown our offerings to include vocational rehabilitation, loss prevention, medical services and more. Though much has changed through the years, our focus continues to be unrivaled customer service, safety, and providing better outcomes for employers and injured workers.

The role

As a member of the Medical Bill Review team, you will review medical bills verifying that the coding field's are accurate in order to submit reimbursement of services provided to injured workers. You will ensure proper payments are made accordance with state appropriate workers' compensation guidelines. Producing high-quality, efficiency-driven and cost-effective bill review steps is key in this role. Investigating billing practices of medical providers and participating in conferences to address payment rationale will be part of the duties in this role as well as promoting and maintaining positive team relationships with internal and external customers. Depending on your experience and education you may be hired as an Associate Medical Support Representative or Medical Support Representative. SFM offers a flexible hybrid work environment, so some office time is required. The Corporate Headquarters are in Minnesota.

This position will provide you many opportunities to grow and stretch yourself while affording you balance in your life. Salary will be based on your experience. Persons with experience working with hospital and surgical coding are highly desired. Apply today and discover why SFM retains their employees and is considered an excellent place to grow your career.

What you will be doing
  1. Reviews standard medical bills, with minimal direction, in accordance with the appropriate state workers' compensation guidelines and Company best practices, utilizing the Mitchell System and maintain a level of accuracy in accordance with Company standards and specific custom rules established by SFM.
  2. Handles and reviews medical bills in a timely fashion and meets production and quality standards per company guidelines and best practices.
  3. Partners with various vendors and other resources for bill review services as needed.
  4. Apply' s learned medical terminology when analyzing medical bills and translates medical coding billing codes per best practices and company protocol and uses the Mitchell system effectively.
  5. Identifies when overpayments are made and submits refund requests when needed and reports said overpayments to a senior member of the team.
  6. Processes provider appeals/reconsiderations for standard bill types by resubmitting for payment or sending professional communication regarding needed documentation or workers' compensation rules.
  7. Under limited supervision, reviews moderately complex bills in accordance with the appropriate state workers' compensation guidelines and Company best practices and escalates more complicated matters as needed.
  8. Reports provider billing practices that are concerning such as potential for overutilization, fraud/abuse or patterns of repeated errors and assists in investigations and obtains guidance before issuing payments seeking guidance as needed.
  9. Ensures the quality of documentation is appropriate for billed charges.
  10. Provides high-quality customer support to various business units within the organization, external customers, and business partners.
  11. Seeks new ways to improve department efficiencies and makes recommendations regarding those improvements, and continues self-development and willingness to learn new skills.
  12. Participates as an active team member offering new ideas and helps less experienced team members as needed.
  13. Responds in a timely fashion to customer questions while applying the appropriate workers' compensation rules and maintains appropriate interactions with persons both within the organization and externally.
  14. Adheres to standards for Company and best practices and agreements made under the Partnership Agreement with the Strategic Business Units and other teams.

We're looking for:
  • To be considered for a higher level, the following requirements are needed as well as the aforementioned skills:
    • Associate's degree or Bachelor's degree in Medical Coding/Health Information, Nursing, or similar field preferred; in lieu of a degree, two or more years of technical training or work experience in a medical coding, medical billing or insurance environment is accepted.
    • Certification from either American Academy of Professional Coders (AAPC) or America Health Information Management Association (AHIMA).
  • For the less experienced role, must have an associate degree or bachelor's degree in medical bill coding/health information, nursing, or similar field preferred; in lieu of a formal degree, two or more years of technical training or work experience in a medical coding, medical billing, or insurance environment is accepted.
  • One or more years' experience working in a customer facing environment highly desirable; experience working in a medical clinic or insurance environment is a plus.
  • Medical coding certification is preferred, or willing to obtain certification with 18 months of employment.
  • Experience in Mitchell Software is a plus and customer service skills are needed
  • Knowledge of workers' compensation insurance and/ or medical coding experience preferred.
  • Ability to understand and use analytical skills relating to business interpretation of medical documents, including CPT, ICD, HCPS, CMS and bundling.
  • Basic math skills and is good with numbers.
  • Strong attention to detail.
  • Strong oral and written communication skills.
  • Proficient in MS Office software applications (Excel, Word, etc.).
  • Effective organizational and time management skills.
  • Ability to work in a fast-paced production-oriented environment.
  • Must be willing to obtain medical coding certification or have certification.

Physical Requirements

Regular attendance is required. Work takes place in a semi paperless environment within an office setting or home office, using standard office equipment such as computers, phones, and photocopiers, which requires being stationary for extended periods of time. While performing the duties of this job, the employee is regularly required to talk or hear, and maintain concentration and focus. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms and work with close vision. This position requires the ability to occasionally lift office products and supplies, up to 20 pounds. Work is performed indoors with little to no exposure to extreme outdoor weather conditions.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Join us Find out why our employees rate us a top employer and choose to stay and grow with us.

SFM Mutual Insurance Company and each of its parent companies, subsidiaries and/or affiliated companies are Equal Opportunity/Affirmative Action Employers. All employment decisions are made without regard to race, color, religion, sex, national origin, age, sexual orientation, marital, familial, or veteran status, medical condition or disability, or any other legally protected classification.

SFM Companies, EEO/AA Employers. SFM is a participant of E-Verify. Applicants have rights under Federal Employment Laws.Learn More

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