Medical Bill Review Analyst/Certified Coder

Job Description

Job Description

About Us: At The Preferred Medical, we pride ourselves on offering a comprehensive suite of services tailored specifically to the needs of the Workers' Compensation industry. Our core mission is to enhance outcomes for injured workers, ensuring their swift and safe return to work. Through our responsive approach, tailored solutions, and focused expertise in PBM, ancillary services, and medical cost containment, Preferred Medical stands as a pillar of support, helping our clients navigate the financial and operational complexities of Workers' Compensation claims.

The Role: The Medical Bill Review Analyst is responsible for reviewing medical bills to ensure accuracy, prevent duplicate charges, detect collision alerts, and confirm correct use of CPT, ICD-10, and HCPCS codes. This role requires applying state fee schedule rules and Workers’ Compensation standards to support clean claim submission, explain denials, and maintain compliance with federal, state, and payer regulations. The MBR Analyst works closely with customer service, billing staff, payers, and providers.

General Responsibilities:

• Review and process medical bills according to state-specific rules, regulations, and guidelines.

• Stay current on multi-state jurisdictional regulations, reporting requirements, mandated fee schedules, and client-specific policies.

• Provide professional customer service to both internal and external clients by:

• Requesting missing or additional information from clients, adjusters, or providers.
• Assisting with issue resolution.

• Review and respond to provider appeals based on fee schedule rules.

• Analyze complex medical documentation, including high-level office visits, reports, and records, using independent judgment.

• Interpret hospital billing guidelines for both inpatient and outpatient claims.

• Process a variety of complex bill types, including med-legal, appeals, consultations, surgeries, hospital services, and technical charges.

• Perform specialized bill review for both PPO and non-fee schedule claims.

• Continue learning bill review methods such as Usual & Customary, fee schedules, and PPO discounts.

• Maintain active certification and required continuing education credits (CEUs).

• Protect the confidentiality of all information handled.

• Complete other duties as assigned.

What You'll Need to Succeed:

• 2+ years of experience in medical coding, preferably in workers’ compensation.
• CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) required; CPC-A considered with relevant experience.
• Strong knowledge of CPT, ICD-10, and HCPCS coding systems.
• Familiarity with CompIQ Solutions billing system is preferred.
• Knowledge of medical terminology, workers’ compensation billing guidelines and fee schedules. Montana and Georgia jurisdiction experience is a plus.
• Excellent attention to detail and organizational skills.
• Strong communication skills for provider and team interactions.
• Ability to work independently in a fast-paced, high-volume environment.
• Must be proficient in Microsoft applications.

What's in it for you:

• Flexible schedule: 10-20 hours weekly (ideally within standard EST office hours)
• Remote Position: work from home*
• Team Culture: Become part of a team that embodies our core pillars of being responsive, tailored, and committed to making a meaningful difference in the lives of injured workers.
• Impactful Work: Make a significant impact in the Workers' Compensation industry, contributing to improved patient outcomes and faster recovery times.

Pay Range Details:

The pay range below is provided in compliance with state specific laws. Pay ranges may be different in other locations. Exact compensation may vary based on skills, experience, and location.

Compensation: $20-$28 per hour, commensurate with experience.
Employment Type: Part-Time, with the potential to move to Full-Time

Remote Work Requirements:

Applicants must reside in any of the following states where Preferred Medical Network has the ability to run payroll: KY, IN, GA, NC, TN, NE, FL, UT. State locations and specifics are subject to change as our hiring requirements shift.

Preferred Medical Network provides use of company IT equipment, and the employee supplies the internet, a hard-wired internet connection and a distraction-free work environment.

Internet Requirements: Ping/Latency 100ms or less; Download 25MBPS; Upload 5MPBS; Packet loss 0% (Cannot use: Mobil hot-spot, tethering, or Satellite ISP service)

Additionally, remote employees are required to be on video in internal calls, meetings and trainings.

Please note, official Preferred Medical recruiters will never contact you with a non @thepreferredmedical.com email address and will never ask for payment to apply or accept any interview or job offer. Nor will you be asked to supply sensitive financial and personal information via phone, email or social media as part of the interview process. If you receive a call, text message, or are contacted via social media from an apparent Preferred Medical official asking for money, you should cease communication immediately and inform the Office of the Federal Trade Commission through its website: https://reportfraud.ftc.gov/.

Preferred Medical Network is an equal opportunity employer, committed to the principles of inclusion and diversity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Preferred Medical Network are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical or mental disability, medical history or genetic information, sexual orientation, gender identity and/or expression, marital status, past or present military service, family or parental status, or any other status protected by the federal, state or local laws or regulations in the locations where we operate.