Job Description

Performs activities related to the accurate interpretation of the governing laws and regulations surrounding the processing and transmission of wage loss and medical payment data related to injured workers, insured or claimants claims. The focus of this role is on handling original bills that tend to be more routine in nature. Refers more complex bill processing items onto unit lead or supervisor.What You'll Do:As a Medical Bill Reviewer, you will:Review, evaluate and in accordance with state regulations and established guidelines, processes original medical, dental, and pharmacy bills.Evaluate bill data in compliance with medical bill processing guidelines. Identifies errors and makes corrections when possible.Determine the completeness of a bill and evaluates whether the bill can be sent back to the provider for required information in accordance with state guidelines.Complete and submits state mandated forms regarding bill review reductions and/or denials in accordance with jurisdictional requirements.Review and issues payment of vendor bills related to claim handling which may include bills for mileage, copy service, court reporters, IME, surveillance, non-emergency transportation, interpreter, utilization review, non-medical consulting, nurse case manager, etc.Use state reference guides and websites, medical bill coding reference material, and rules built into the bill paying system to determine appropriate resolution and payment of billed item. Researches and analyzes provider NPIs/license numbers.Additionally, you will: Respond to inquiries from, medical providers, attorneys, insured, claimants, and other internal company employees regarding payment for services provided.May communicate with medical providers regarding payment or denial of payment.Perform other job-related duties as assigned from time to time.What it takes:Technical Degree or equivalent work experience.Technical diploma or Associate Degree in Health Informatics/Health Information/Medical Coding preferred.1-3+ years of related work experience in a medical office, insurance environment, or medical coding beneficial.Basic knowledge of ICD9/ICD10, CPT, HCPCS codes necessary for accurate processing.PC knowledge including Excel as well as keyboarding, math aptitude, and organizational skills.Proficient analytical and decision-making skills with the ability to work independently.High level of communication, customer service and telephone skills required.Ability to work within deadlines, maintain confidentiality, and work with detail and a high level of accuracy is essential.What You'll Receive:At Sentry, your total rewards go beyond competitive compensation. Below are some benefits and perks that you'll receive.Sentry is happy to offer flexibility through a scheduled Hybrid work model for those who work in an office. Monday and Friday work from home if you choose to, Tuesday through Thursday you'll work in office.As a Sentry associate, you will have an in-office workspace and materials for your home office. In addition to the laptop, you will receive prior to your start, Sentry will provide equipment for your home office. Meal Subsidy available for associates who report to an office.401(K) plan with a dollar for dollar match on your first eight percent, plus immediate vesting to help strengthen your financial future.Continue your education and career development through Sentry University (SentryU) and utilize our Tuition Reimbursement programGenerous Paid-Time Off plan for you to enjoy time out of the office as well as Volunteer-Time offGroup Medical, Dental, Vision, Life insurance, Parental leave, and our Health and Wellness benefits to encourage a healthy lifestyle.Well-being and Employee Assistance programsSentry Foundation gift matching program to encourage charitable giving.About Sentry:We take great pride in making Forbes' list of America's Best Midsize Employers. A lot of different factors go into that honor, many of which contribute to your job satisfaction.Our bright future is built on a long track record of success. We got our start in 1904 and have been helping businesses succeed and protect their futures ever since. Because of the trust placed in us, we're one of the largest and financially strongest mutual insurance companies in the United States. We're rated A+ by A.M. Best, the industry's leading rating authority.Our headquarters is in Stevens Point, Wisconsin, with offices located throughout the United States. From sales to claims, and information technology to marketing, we enjoy a rewarding and challenging work environment with opportunities for ongoing professional development and growth.Get ready to own your future at Sentry. Opportunities await!Talent Acquisition SpecialistDonna PaschallEqual Employment OpportunitySentry is an Equal Opportunity Employer. It is our policy that there be no discrimination in employment based on race, color, national origin, religion, sex, disability, age, marital status, or sexual orientation.

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