Manager, Bill Review

Provides strategic and technical bill review for management of vendor. Accomplishes Managed Care objectives by managing processes; planning and evaluating Medical bill review activities. Technical abilities and industry-specific knowledge to oversee the bill review process. Maintains a solid understanding of AmTrust's mission, vision, and values. Upholds the standards of the AmTrust organization.

Develop, recommend and implements short and long term objectives consistent with company business goals, guidelines and program
• Effectively plan responsibilities and manage activities, utilizing staff resources to meet department goals in accordance with established business plans.
• Monitor and analyze significant workers compensation fee schedule changes in service territories that may impact claim operations; communicates conclusions and recommendations to the appropriate parties
• Interprets hospital review guidelines for both inpatient and outpatient claims.
• Promote effective communication among and between work groups, and between management and employees. Collaborate with claim offices and vendor's.
• Ensure quality management of medical bill vendor in accordance with regulatory changes.
• Provide coaching and training of field office leadership and claims adjusters.
• Experience developing training material for workers compensation bill review.
• Ability to identify billing trends
• Responsible for preparing reports for management, by collecting, analyzing, and summarizing claim information. Keeps apprised of changes in the law and court procedures affecting claims in jurisdictions supervised.
• Establishes the appropriateness of a final reimbursement outcome by making the distinction between and knowing when to apply either Fee Schedule reduction, PPO reduction, Usual and Customary reduction, or Medicare reduction.
• Assessing payments against regulatory or administrative charges, coding, and billing errors.
• Assisting in the development and implementation of new audit/review methodologies to identify overpayments and underpayments to providers.
• Developing, maintaining, and ensuring adherence to multiple project schedules.
• Participating in planning, daily meetings
• Respond daily to billing related questions
• Provide professional customer service to our clients in the field
• Strong communication, including writing, speaking and active listening

Required:

• Bachelor's Degree or equivalent experience
• 2+ years of claims experience in positions of increasing responsibility
• Knowledge of CPT, ICD-9, HCPC coding methodology
• Extensive knowledge of claims regulations and applicable laws with specific knowledge of Workers' Compensation within servicing states
• Extensive knowledge of workers compensation fee schedule guidelines, medical billing, and medical terminology
• Experience in bill processing platforms
• Excellent verbal and written communication skills

Preferred:

• 2+ years of Medical Bill Review specific experience
• Certified Professional Coder
• Previous experience in a leadership position with proven record of goal achievement and superior customer service
• Experience with State and external accreditation managed care audits and with writing and implementing program level policy and procedures

This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust reserves the right to revise this job description at any time.

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AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.