2 knowledge center representative i jobs found in Lansing

SUMMARY:  Primarily responsible for the following:  Authority to evaluate which submitted vendor physical and phone audits and decide which require further analysis; approval, completion and processing mail audits; processing adjustments, and reviewing phone and physical audits requiring further review in a multi-functional business unit.  Provides direct customer service via phone, fax, and e-mail to internal and external customers including, but not limited to; Business Development Consultants and Service Center representatives, Finance, and other Premium Audit staff, as well as agents, attorneys, NCCI / regulatory bureaus, and policyholders. PRIMARY RESPONSIBILITIES: •   Actively engages in the identification of solutions for multiple or cross-functional business areas.  Has an understanding of the direction of the overall industry and evaluates the related impact. •   Evaluate and decide in a timely manner which vendor audits submitted require further review and provide...

SUMMARY Medical Bill Review Specialist I Primarily responsible for analyzing bills for multi-state Workers Compensation medical claims to determine appropriateness of services billed. Responsible for analyzing simple billings by utilizing our Medical Bill Review (MBR) software to determine appropriateness of codes. Responsible for making bill review processing determinations according to rules, regulations, and/or third-party partners. Medical Bill Review Specialist II Primarily responsible for performing technical review of more complex medical bills, including modifiers, anesthesia, & psychiatric. Responsible for analyzing billings including outpatient hospital and multiple surgeries by utilizing our Medical Bill Review (MBR) software to determine appropriateness of codes and excessive charges. Also responsible for analyzing assigned medical bills to determine compliance with business rules, client specific requirements and multiple state rules, regulations and...