Bill Reviewer-ForeSight

Posted 3 months ago
Description Foresight Medical, part of the Paradigm Family of Companies is currently seeking a Bill Reviewer. ForeSight Medical is a cost containment company that is dedicated to surgical implant claims in the workers compensation space. ForeSight combines unparalleled experience with analytics and a proprietary Implant Management Platform (branded Fusion) to objectively and defensibly reduce the cost of surgical implants.  The primary services offered by ForeSight are surgical implant bill review and claim payment negotiations. The Bill Reviewer is responsible for appropriately adjudicating workers compensation claims containing implanted devices. Essential Functions:
  • Perform detailed analysis of all claim related documents that may be associated with an implantable device procedure billing.
  • Utilize company proprietary software to document analysis of claims and provide recommendations of payment to clients.
  • Responsible for ensuring that both accuracy and efficiency is maintained throughout our operational processing of client implant case referrals.
  • Understand and comply with all HIPAA and SOC2 requirements necessary in working with designated PHI.
Requirements Competencies:
  • Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
  • Surgical healthcare knowledge a must
  • Experience/Knowledge of medical billing & common coding practices including: ICD-9/10 coding and medical terminology
  • Workers’ Compensation claims experience a plus
  • Implant product or procedural knowledge a plus
  • Proven critical thinking skills that demonstrate analysis/judgment
  • Sound decision making with focus on attention to detail and quality awareness
  • Strong verbal, written communication skills and customer service skills gained through previous work experience
  • Computer literacy, including working knowledge of MS Office Product Suite; i.e. Word, Excel, PowerPoint
Supervisory Responsibilities:
  • This position has no supervisory responsibilities.
Work Environment:
  • This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical Demands:
  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. The employee is frequently required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee must be able to lift a minimum of 10lbs.
Position Type/Expected Hours of Work:
  • This is a full time role (40 hours per week). Days and hours of work are Monday through Friday, set hours determined by Director. Occasional evening and weekend work may be required as job duties demand.
  • No travel is expected for this position.
Required Education and Experience:
  • Associate degree or equivalent number of years’ experience.
  • Minimum typing speed of 45 WPM.
Other Duties:
  • Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

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