WC MED BILL REVIEW SPECIALIST
On-site · Long Island City, New York, United States
Job Summary
Performs advanced review of Workers’ Compensation medical bills to ensure regulatory and coding compliance under NYS WCB mandates. Applies CPC-level coding knowledge to verify appropriate CPT/HCPCS modifiers, CARC/RARC codes, and adherence to NYS WCB e-billing requirements; utilizes EAPG and DRG methodologies and multi-state rules to evaluate inpatient/outpatient claims, prepare detailed objections for disputed bills, and serve as liaison for outside reviews. Reviews, logs, and reports issues; collaborates with Nurse Case Manager and Bill Unit Manager to ensure timely resolution of billing disputes, penalties, and payment processing; supports backlog reduction and ensures timely payments while maintaining audit-ready documentation.
Required Qualifications
- Working knowledge of the NYS Workers' Compensation Fee Schedule, Medical Treatment Guidelines, Department of Health APR-DRG and APGs Rules, Regulations and Reimbursement Components
- Knowledge of medical terminology, ICD9/10 and CPT coding and billing for Inpatient and Outpatient surgeries
- Coding and billing certification (CPC level)
- Ability to process bills according to quota with maximum accuracy
- Basic knowledge of computers and ability to enter alpha/numeric data accurately
- Effective compensation skills and basic math skills
- Excellent organizational skills and ability multitask and prioritize work
- Ability to work with minimal direction and demonstrate attention to detail
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