Bill Review Analyst Iii (Mandaluyong)

The Bill Review Services Associate III (Bill Review Analyst III) is responsible for reviewing and analyzing complex and high-value medical bills related to both Workers' Compensation and non-Workers' Compensation claims. This role requires proficiency in various reimbursement methodologies and billing practices, including hospital and surgical claims. The Associate also serves as a resource for junior team members and provides expert-level support for compliance and quality assurance activities. 
Key Responsibilities: Review specialized and complex medical bills, including those related to hospital services, surgeries, and high-level physician services for Workers' Compensation, auto liability, and other claims. 
Determine appropriate reimbursement methodology, applying knowledge of Fee Schedule reductions, PPO discounts, Usual and Customary reductions, or Medicare-based reductions. 
Defend and explain reimbursement decisions to healthcare providers and clients using clear and professional communication. 
Analyze high-level medical documentation, such as office visit notes, diagnostic reports, and treatment records, to determine appropriate billing outcomes. 
Interpret and apply hospital billing guidelines for both inpatient and outpatient claims. 
Conduct compliance test studies with a focus on accuracy and quality, often under tight deadlines. 
May serve as an informal mentor or resource to junior bill review team members. 
Ensure all work is compliant with company policies, regulations, and applicable industry standards. 
Perform additional duties as required. 
Qualifications:  Bachelor's degree in a healthcare or business-related field, or equivalent experience 
3+ of experience in medical billing or healthcare claims review, with direct experience in Workers' Compensation bill review processing required. 
Certification in medical coding (e.g., CPC, CCS, or equivalent) is preferred. 
Advanced understanding of medical billing standards, coding systems (CPT, ICD, HCPCS), and reimbursement methodologies. 
Strong analytical skills and the ability to interpret complex clinical documentation. 
Excellent written and verbal communication skills, particularly in defending billing outcomes. 
High attention to detail and ability to work with minimal supervision. 
Familiarity with hospital billing processes and state-specific Workers' Compensation fee schedules. 
Ability to support and provide informal guidance to less experienced team members. 
Proficiency in medical billing software and Microsoft Office tools. 

? Onsite training then will transition to hybrid setup in Mandaluyong City (1 day onsite, 4 days remote)
------------- All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, ethnicity, age, disability, marital status, or any other characteristic protected by law.


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