General Purpose
As a Medical Dispute Specialist, you will be responsible for reviewing medical bills and applying, validating, and defending WellRithms’ reimbursement methodology for each case. This role requires experience in medical billing, CPT coding, the IDR (Independent Dispute Resolution) process, and medical fee dispute procedures. You must be able to review and process disputed bills efficiently and with attention to detail. Strong communication skills are essential, as you will interact with leadership, internal counsel, medical providers, clinical staff, and other stakeholders.
Duties & Responsibilities
- Conduct thorough reviews of medical bills, records, and itemized charges to determine appropriate reimbursement.
- Understand and follow client-specific protocols, workflows, and operational requirements for all medical bill types.
- Review, process, and validate the correct use of CPT codes in medical billing.
- Identify and correct CPT coding errors in collaboration with the Bill Review department, adhering to established workflow procedures.
- Review reconsiderations and medical bill disputes to assess whether additional documentation warrants further payment.
- Research disputed bills and provide clear documentation and justification to state entities or medical providers when no additional reimbursement is recommended.
- Adhere to all required deadlines and turnaround times for appeals and dispute responses.
- Meet daily productivity targets and quality assurance standards for claims reviewed.
- Collaborate effectively within a team, demonstrating a cooperative and supportive attitude.
Qualifications
- High school diploma required; some college coursework preferred.
- Minimum of 5 years’ experience in healthcare or a related field preferred.
- Experience with workers’ compensation or group health insurance is required.
- Strong knowledge of CPT coding and medical terminology.
- Familiarity with HCFA 1500 and UB-92 billing forms.
- Understanding of workers’ compensation fee schedules is preferred.
- Proven ability to organize, plan, and manage complex tasks.
- Excellent written and verbal communication skills.
- Ability to meet deadlines in a fast-paced, time-sensitive environment.
- Skilled in reviewing medical billing forms to identify required and relevant information.
- Proficient with computer applications, including Microsoft Word, Excel, and Outlook.
- CPC (Certified Professional Coder) certification or education is a plus, but not required.
