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Provider Med Bill Auditor

Company: Pinnacol Assurance
Location: Denver
Posted on: August 24, 2019

Job Description:

Pinnacol Assurance does just one thing, and does it better than anyone: provide caring workers' compensation protection to Colorado employers and employees. And while we may be a little biased, we believe that our work shapes communities and changes lives.

We have big hearts and love big ideas. We celebrate continuous improvement, innovation, compassion, teamwork, integrity and excellence. Speaking of celebrating, we love having fun at work. We host holiday parties, on-site painting classes, and employees love our yoga classes and book club, too.

What you'll do:

Ensure that providers are in compliance with Division rules and regulations and healthcare industry coding guidelines

.What you can expect:

Identify trends in billing errors, make recommendations on how to prevent future errors, document findings; take steps to collect overpayments


  • Perform accurate audits on a focused subset of bills to identify billing errors
  • Identify vendor billing error trends and document those trends to develop training and provider action plans
  • Educate providers and vendors when trends are identified to prevent future errors and coordinate with Provider Network Management Department when appropriate
  • Run reports as needed to identify issues to be monitored and addressed
  • Maintain accurate documentation of all audit findings including billing trends, recommendations for improvements, overpayments and collection of funds
  • Present findings and make recommendations to management for improvements based on audit results
  • Collaborate with Provider Network Management Department on practice variation initiatives to reduce unnecessary medical spending
  • Notify quality analysts of any potential system issues or enhancements identified during the audit process
  • Assist with complex bill processing to ensure timely and accurate turnaround
  • Provide daily support to team regarding any coding questions


    • Remain current on coding changes; communicate all coding changes to staff
    • Attend educational meetings and keep current with required certification and licensures
    • Inform leadership of any suspicious or fraudulent billing
    • Assist Med-Pay Liaison with bill payment review to determine if procedure is allowed
    • Assist with special projects
    • Perform other duties as assigned


      What you'll bring to the table:Bachelor's Degree strongly preferred. Relevant work experience (similar kind of work at a similar level of work as described in the essential duties) may be substituted for the bachelor's degree. Completion of a degree is encouraged and supported. Five years' experience in medical coding/bill payment, auditing required. Basic Excel competency required, advanced skills preferred. Coding Certification (CPC) and/or Payer Certification (CPC-P) certification required. Extensive knowledge of anatomy and physiology and medical terminology required. Knowledge of Workers Compensation guidelines and rules strongly preferred. Must pass the Certified Professional Medical Auditing (CPMA) Exam within one year of hire.

      WORK ENVIRONMENT/PHYSICAL ACTIVITIES:



      Regular attendance required. Extensive telephone and computer work in an office and home environment. Attendance at Company/Department meetings required.

      We can't do our work without people like you.

      Our employees are extraordinary and committed to making a difference. Here's some of the ways we show our appreciation.



      • Our benefits go beyond the basics. You'll get to choose from diverse benefit offerings for medical, dental and vision.
      • We care about each other. We enjoy a positive, collaborative work environment. We are hard workers and high performers.
      • Take a day (or 20!) off. Enjoy 20 paid days off your first full year plus eight paid holidays annually.
      • Take care of yourself. Sign up for unique wellness programs, including on-site, company-paid fitness facilities and classes
      • Get your learning on. We promote a learning culture to help you master your current job and cultivate the skills of the future through a variety of on-site, online, and off-site professional development opportunities.
      • Give back and get paid. Through our employee volunteer program, Pinnacol in Action, employees receive paid time off to volunteer with Colorado nonprofits.
      • Share in our success. You'll have the opportunity to earn a quarterly incentive, up to 20 percent of your annual base salary, when your team exceeds their goals and objectives.

        When we find the right person, we try to put our best foot forward with an offer that excites you. We consider what you'd like to be paid, what similar jobs pay in the Denver area and make sure there's equal pay for equal work among those you'll be working with.

        Want to love your work? Apply today!

Keywords: Pinnacol Assurance, Colorado Springs , Provider Med Bill Auditor, Accounting, Auditing , Denver, Colorado

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