1. Review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.
2. Responsible in making sure that provider bills are accurately keyed based on HCFA/UB billings and either paid or denied depending on claims examiner instructions and state specific guidelines.
3. Handles provider appeals as appropriate to fee schedule and contractual disputes.
4. Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.
