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Medical Bill Review Technical Analyst IMS Cost Containment Lake Forest, CA Job Details Full-time $25 - $30 an hour 21 hours ago Benefits Health savings account Paid holidays Disability insurance Health insurance Dental insurance 401(k) Flexible spending account Paid time off Vision insurance 401(k) matching Life insurance Retirement plan Qualifications Teamwork Research Certified Professional Coder System testing Data entry Medical terminology

Full Job Description Summary of Functions:

Intelligent Medical Solutions (IMS) is seeking an experienced Workers' Compensation Medical Bill Review Technical Analyst to perform complex medical bill reviews to determine if the supporting documentation substantiates the provider's billed charges. Resolve escalated reimbursement issues, and support accurate application of fee schedules, provider contracts, and client-specific requirements. This position serves as a technical resource for the bill review team, researching reimbursement questions, identifying processing errors, and assisting with system testing and process improvements. The ideal candidate has strong workers' compensation bill review experience and can translate complex reimbursement requirements into clear, practical guidance.

Essential Duties and Responsibilities:

Complex Bill Review and Reimbursement Analysis Review complex workers' compensation medical bills, including professional, outpatient facility, inpatient hospital, surgical, implant, and ancillary charges. Apply applicable state fee schedules, reimbursement methodologies, provider contracts, and client-specific instructions. Analyze CPT, HCPCS, revenue codes, modifiers, units, and supporting documentation to identify coding or reimbursement discrepancies. Research bills requiring manual pricing, fee schedule interpretation, or review of reimbursement exceptions. Document the rationale and supporting sources for payment recommendations and adjustments. Escalations and Dispute Resolution Serve as a resource for escalated coding, pricing, and reimbursement questions. Review provider reconsiderations and payment disputes to determine whether the original review was accurate and supported. Identify the cause of review discrepancies and recommend corrections. Prepare clear explanations of findings for internal teams and, as assigned, clients or providers. Escalate matters requiring clinical judgment, legal interpretation, or management approval. System Support and Quality Assurance Investigate potential bill review system errors involving pricing, edits, fee schedule application, or client configuration. Work with operations and technical teams to document issues, communicate expected results, and verify corrections. Assist with testing fee schedule updates, reimbursement rules, and system changes before implementation. Perform quality reviews to identify recurring errors and recommend corrective action. Help maintain technical reference materials, review procedures, and jurisdiction-specific guidance. Support training and coaching on complex bill review topics.

Qualifications:

Five or more years of workers' compensation medical bill review experience, including complex reimbursement analysis. Strong working knowledge of state workers' compensation fee schedules and reimbursement methodologies; experience across multiple jurisdictions preferred. Experience reviewing professional and facility bills, including

CMS-1500

billing formats. Knowledge of medical terminology, CPT and HCPCS coding, modifiers, and revenue codes. Ability to research reimbursement requirements, resolve discrepancies, and clearly explain technical findings. Experience with medical bill review platforms and Microsoft Excel. Strong analytical, organizational, and problem-solving skills, with the ability to work independently and collaborate with operations, quality assurance, and technical teams. Experience reviewing surgery bills is a plus. Experience with quality assurance, system testing, reimbursement configuration, root-cause analysis, or staff training preferred. CPC, CCS, or another relevant coding credential preferred.

Work Environment:

Fast-paced administrative setting involving significant data entry, documentation review, and computer-based work Collaboration with claims departments, provider relations, Medical Bill Review Analysts, Auditors, IT Team members, and Bill review Trainers. Training will be in our office- TBD on timeline. Depending on production and meeting metrics expectations, remote work may be available, but not guaranteed and may be revoked at any time.

Benefits:

401(K) and 401(K) Matching upon completion of 90 days of employment Health, Dental, Vision, and Long-Term Disability Insurance after 60 days of employment PTO upon completion of 6 months of employment, which will begin accruing at the rate of 5 hours per pay period (15 days per year). After 5 years of employment, full-time employees accrue up to 20 days per year. After 10 years of employment, full-time employees accrue up to 25 days per year. 10

Paid Holidays Per Year Compensation:

$25.00 to $30.00 per hour depending on experience

Pay:

$25.00 - $30.00 per hour Expected hours: 40.0 per week

Benefits:

401(k) 401(k) matching Dental insurance Flexible spending account Health insurance Health savings account Life insurance Paid time off Retirement plan Vision insurance Application Question(s): How many years of workers' compensation medical bill review experience, including complex reimbursement analysis? Do you have strong working knowledge of state workers' compensation fee schedules and reimbursement methodologies; experience across multiple jurisdictions? Ability to

Commute:

Lake Forest, CA 92630 (Required)

Work Location:

In person