Job Description

Medical Payment Analyst

This full-time position requires employees to be able to work from our downtown Boise, Idaho office at least two days per week (Tues/Thurs). Pay starts at $50,000 annually.

SIF, Idaho Workers’ Compensation is a leader in Idaho workers’ compensation. Because we live and work locally, we recognize that our customers are the backbone of Idaho’s economy and we are proud to offer services that protect their businesses and injured workers, and support their financial strength. We empower our team to put people first, grow professionally, and have fun. At SIF, we’re passionate about Idaho and we’re passionate about what we do.

We are currently seeking a Medical Payment Analyst to join our Claims Cost Containment team!

As a Medical Payment Analyst, you will be responsible for analyzing workers’ compensation medical bills, invoices, and claimant reimbursements to determine the appropriateness for payment and/or reimbursement based upon compensability and medical relatedness.

We’ll be looking for YOU to:

• Review and process medical bills in SIF’s strategic bill review partner’s Adjuster Portal software and in SIFComp to confirm cost containment practices are applied in order to reduce the total cost of risk to SIF and its policyholders.
• Responsible for the review, determination and approval of medical bills based upon relatedness to the injury or occupational disease within an authority level up to $50,000 per bill.
• Process in-house medical bills, invoices and claimant reimbursements according to applicable fee schedules and assign appropriate explanation of review (EOR).
• Communicate with medical providers, examiners, supervisors, nurses, injured workers, and other appropriate parties to make payment determinations and/or denials in accordance with applicable state rules and regulations as well as company policies and procedures.
• Verify procedure codes using Healthcare Common Procedure Coding System (HCPCs), Current Procedural Terminology (CPT), International Classification of Diseases (ICD9-10) and Correct Coding Initiative (CCI).
• Provide superior customer service to examiners, injured workers, nurses, providers and vendors.
• Audit medical bills for accuracy, duplication, and reasonableness.
• Responsible for the timely processing of medical bills and claimant reimbursement for payment.
• Review and coordinate resubmissions of reconsiderations and corrected bills.
• Research any billing, invoicing or reimbursement issues as necessary.
• Collaborate with bill review software vendor as necessary to resolve any questions or issues with billing, payments, software system, etc.

Your background should include:

• High School Diploma or equivalent.
• Certified Medical Coder (CPC) certification highly desired.
• Two+ years’ experience in a healthcare environment or related field.
• Knowledge of medical diagnostics, procedural terminology, and report interpretation.
• Hands-on experience applying ICD and CPT medical procedure codes.
• Proficiency using desktop applications, e.g., Microsoft Office products, to generate emails, forms/letters, reports, and presentations, as well as search and download information from the internet.
• Experience interpreting/explaining policies and procedures.
• Strong interpersonal communication skills and the ability to work effectively with all levels of internal management and staff, as well as individuals outside the organization.
• Ability to use critical thinking skills to make independent decisions affecting injured workers and policyholders, as well as SIF.
• Strong attention to detail and a high level of organizational skills.
• Ability to complete work assignments independently with minimal supervision.

What you can expect!

• A fun, collaborative culture
• Work-life balance
• Professional development opportunities that are more than just “talked about”, they actually happen!
• Competitive salary
• Generous paid time off
• Amazing insurance benefits package
• Retirement benefits that rock – membership in PERSI (pension plan) as well as retirement savings options via 401(k) and 457 plans

SIF values diversity and we are an equal opportunity employer. Please note that applicants need to have legal authority to work permanently in the U.S.

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