Workplace Type: Onsite
Employment Type: FT
Job Location: Barberton, OH
JOB SUMMARY
The Medical Bill Examiner is responsible for conducting quality audits on medical bills submitted to CHM and assigning personal responsibility amounts. This role ensures compliance with CHM Guidelines while maintaining high standards of accuracy and quality assurance.
PRIMARY RESPONISIBILITIES
- Audit itemized bills for accuracy (e.g., patient name, benefit code, place of service, incurred date, total charges)
- Review documentation to ensure services rendered and clinical complexity are accurate and complete
- Confirm member eligibility and verify monthly contributions and required documentation
- Identify duplicate bills and ineligible charges
- Process applicable medical discounts
- Escalate or de-escalate bills to appropriate departments for further review
- Assign yearly personal responsibility based on membership level and incident qualifying amount
- Identify opportunities to improve quality and productivity
- Support implementation of policies and procedures aligned with CHM Guidelines
- Maintain an error rate of 1% or less
- Perform other duties as assigned.
CORE COMPETENCIES & SKILLS
- Attention to detail
- Analytical thinking
- Communication and collaboration
- Problem-solving
QUALIFICATIONS
- High school diploma or equivalent
- Medical background preferred
- Ability to maintain confidentiality and comply with HIPAA
- Strong analytical and research skills with high attention to accuracy
- Excellent written and verbal communication skills
- Strong organizational and multitasking abilities
- Detail-oriented and process-driven
- Proficiency with PC systems and Microsoft Office (Outlook, Word, Excel, Access)