Bill Reviewer III

AvonRisk Medical Bill Reviewer

AvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, managed care, and risk management across 32 states. With nearly 700 professionals and brands including Intercare, InterMed, George Hills, and AS&G Claims Administration, we're a people focused, operations driven organization that prioritizes reasonable caseloads, strong training, collaborative teams, and expert support. We invest in tools and workflows that reduce friction—not increase volume—and create real career paths for professionals who want to grow their careers or move into leadership. We are a focused, operations driven organization that prioritizes reasonable caseloads, strong training, collaborative teams, and expert support. At AvonRisk, you're part of a team that values good judgment, curiosity, and accountability, and gives you the support to succeed.

Under limited supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers' compensation fee schedule by performing the following duties.

• Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output.
• Performs preliminary screening for appropriateness and medical necessity of services rendered.
• Uses CPT and ICD9/ICD10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational.
• Flags any problem bills to the BR supervisor.
• Communicates with clients and/or providers to clarify information.
• Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers.
• Ability to price hospital and surgery bills to applicable fee schedules.
• Ability to process reconsideration requests as assigned.
• May specialize in state specific or client specific areas of responsibility.
• May assist in answering provider calls.

To perform the job successfully, an individual should demonstrate the following competencies:

• Design - Demonstrates attention to detail.
• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions.
• Team Work - Supports everyone's efforts to succeed.
• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
• Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent oral and written communication skills.

Education and/or Experience: High school diploma or general education degree (GED), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers' comp environment.

Salary Range: $26-$28 hr

The salary range listed is an estimate. Actual compensation will be determined based on several factors such as a candidate's experience, qualifications, skill set, and work location.

We take care of our people so they can take care of their work and their teams! AvonRisk offers a competitive, people first benefits package designed to support your health, financial security, and career growth, including:

• Comprehensive medical, dental, and vision benefits
• Company contributions to HSA and FSA plans
• Employer paid life and disability insurance
• 401(k) with company match
• Paid time off (PTO) and company paid holidays
• Learning and development opportunities that support real career advancement
• Employee assistance resources and a supportive culture that values balance and wellbeing

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.