October 29, 2011 (last updated 21 hours 26 min ago)
Committed. Competitive. Constructing our Future. That's Travelers. We are one of the leading insurance companies in the United States. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy, and a workplace in which you truly can make a difference.
SUMMARY: This position is responsible for analyzing medical/ surgical bill data to identify trends in new medical procedures, devices and creative billing practices and collaborate on best response. Developing and presenting recommendations to address each unique billing trend including workflows and procedures to be followed by medical/surgical bill reviewers. Setting up and overseeing pilots for approved projects. Developing, implementing and documenting new procedures, phone scripting, quality standards and training materials for each new product/protocol. Serves as the subject matter expert for new protocols developed.
PRIMARY DUTIES: Examine, review, and interpret data, for potential new product/protocols. Assess the cost-benefit of potential new products for viability. Present data analysis and recommendations to Management. Work with Travelers Legal Department and State Regulatory Agencies to ensure that a new protocol will be viewed as highly fair and reasonable. Set up and conduct potential new product pilot(s), including; . Writing pilot procedures . Process the targeted bills, through pilot period, to test procedures. . Daily assessment and modification of procedures if needed. . At conclusion of pilot, document the assessment of pilot results. For new products/ protocols going to production: . Create Explanations of Review (EORs), training material & telephone scripting.. . Conduct training for Medical/Surgical Bill Reviewers. . Oversee the introduction of the new product into operations and be available for questions and problem solving. .Make adjustments as necessary. .Ensure Quality Review is effective. EDUCATION/COURSE OF STUDY: College degree preferred and /or equivalent work experience Nursing, surgical technician and/or clinical experience a plus. Demonstrated success in medical bill reviewer or medical billappeals reviewer preferred. Strong knowledge of Workers Compensation fee schedules and Travelers payment rules preferred. Certified Coder preferred or commensurate experience with the following resource materials: Current Procedural Terminology (CPT), International Classification of Diseases-9 Revision (ICD-9), Healthcare Common Procedural Coding System- 9th Revision (HCPCS) codes, Itemized hospital bills, hospital records. Able to handle the complex and unusual coding and procedures Strong working knowledge of human anatomy and medical terminology. Strong math skills. Must have mathematical analysis ability to conduct cost-benefit analysis. Strong computer skills and software applications, Microsoft Office Word, Power point, and Excel. Must be able to create and manipulate Excel spreadsheets for use in analysis and use Word and Power Point to create effective presentations and training tools.
OTHER: Competencies: Strong analytical and problem solving skills Strong interpersonal relations skills. Strong verbal and written communication skills including effective sentence construction, grammar, spelling, and punctuation Strong ability to influence and manage conflict Ability to perform and be flexible in a high production environment Strong project management skills Superior Organizational Skills and Attention to Detail Commitment to Task Continuous Learning Strong teamwork Decision Making and Problem Solving skills Decisiveness Sense of urgency Flexible and creative Travelers is an equal opportunity employer. We actively promote a drug-free workplace.
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