GENERAL DESCRIPTION

• The State Office of Risk Management (SORM) is looking for a Medical Clean Bill Analyst. As the Medical Clean Bill Analyst, you will perform review, oversight, report findings and process medical bills from various providers to ensure effective and accurate processing of the medical benefits provided to injured workers are appropriate, timely, and cost-effective.
• This individual must be capable of working under general supervision and making recommendations designed to enhance external and internal compliance, efficiency, and effectiveness.
• SORM is a diverse and inclusive state agency. We serve the public by directly serving other state entities with their workers’ compensation claims, insurance and risk management programs, and continuity of operations (COOP) plans. SORM’s unique culture embraces communication, creativity, and critical thinking. We hire results-oriented, curious, innovative, and adaptable people with a strong desire to help our clients, and one another, succeed. SORM continually seeks to enhance the agency’s expertise and service by hiring talented people whose aspirations align with the Office’s vision. If you are a service-minded professional with the desire to work effectively and collaboratively with diverse colleagues and are looking for the stability of state service, we would love to visit with you.

ESSENTIAL POSITION FUNCTIONS

• Analyze medical data (Claim, Payee, Provider, etc.) on medical billing forms to ensure accurate results within the medical billing process including associated internal and vendor platforms.
• Proactively identify system and/or bill review issues and provide feedback to your lead or supervisor.
• Add or edit Provider and Claim information as appropriate.
• Examines, investigates, analyzes, and reports on all aspects of the medical benefits provided to injured workers to ensure the medical benefits provided to injured workers are appropriate, timely, cost-effective, and in compliance with state statutes and regulations
• Identifies performance and compliance issues; develops recommendations designed to enhance external and internal compliance, efficiency, and effectiveness; and provides advice on implementation
• Provide customer service to internal and external customers in a professional and respectful manner
• Addresses day-to-day inquiries related to medical bills
• Meets daily, monthly, quarterly, and annual performance expectations and statutory deadlines related to payment and audit of medical benefits
• Represents the interests of the agency in a professional, courteous, and respectful manner
• Performs related work as assigned
• Maintains relevant knowledge necessary to perform essential job functions
• Attends work regularly in compliance with agency leave policy and agreed-upon work schedule
• Ensures security and confidentiality of sensitive and/or protected information
• Complies with all agency policies and procedures, including those pertaining to ethics and integrity

MINIMUM QUALIFICATIONS

• Education: Graduation from high school or equivalent
• Experience: 1 year of Medical provider billing, medical bill review, medical bill processing, or medical bill audit.
• Knowledge, skill, and ability to analyze, interpret, and apply workers’ compensation statutes and regulations
• Knowledge, skill, and ability to analyze, interpret, and apply coding systems such as CPT, ICD, HCPCS, and NDC numbers
• Knowledge of medical terminology and guidelines for medical services, charges, and payments; ability to read and understand medical bills and records
• Skill and ability to exercise sound judgment and effective decision making
• Skill in exercising sound judgment and effective decision making
• Ability to obtain and maintain an adjuster’s license in workers’ compensation claims in Texas {License required within 1 Year of employment}
• Ability to make prompt, intelligent decisions based upon detailed analysis of complex issues
• Ability to establish priorities and manage multiple activities to meet deadlines and internal performance expectations
• Ability to work independently, complete assignments with attention to detail and high degree of accuracy, and follow through on assignments with minimal guidance and direction
• Ability to maintain accurate records, track assignments, and monitor the status of multiple activities
• Demonstrated interpersonal skills including tact, diplomacy, and flexibility to work effectively with other staff and management as well as external customers
• Ability to receive and respond positively to constructive feedback
• Demonstrated ability to use computer applications, including word processing, data entry/retrieval, and bill review systems
• Ability to arrange for personal transportation for business-related travel
• Ability to work more than 40 hours as needed and in compliance with the FLSA
• Ability to lift and relocate 30 lbs.
• Ability to travel (including overnight travel) up to 5%

PREFERRED QUALIFICATIONS

• Education: Graduation from an accredited Medical Billing/Coding secondary education program or four-year college or university with major coursework in health care information management or a related field is generally preferred. Experience and education may be substituted for one another.
• Certificate: Certified Coder (CPC; CPC-H; CPC-P; AAPC)
• Certificate: Hold and maintain a Texas claims adjuster license

TO APPLY
All applications for employment with the State Office of Risk Management must be submitted electronically through www.WorkInTexas.com. A State of Texas application in WorkInTexas (WIT) must be completed to be considered OR Submit a State of Texas Application for Employment to: Attn: Linda Griffin, State Office of Risk Management, P.O. Box 13777, Austin, TX 78711-3777. Military Crosswalk information can be accessed at https://hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_ComplianceInspectionandInvestigation.pdf

THE SORM IS AN EQUAL OPPORTUNITY EMPLOYER