Bill Review Negotiation Specialist

ABOUT US:

Ethos Risk Services is a leading insurance claims investigation and medical management company committed to providing better data that translates into better decision-making for our clients. We are at the forefront of innovation in our space, and our success is driven by a dynamic team passionate about delivering exceptional services to our customers.

JOB SUMMARY:

Our dynamic Ethos Medical Management Team is growing and seeking a full-time Bill Review Negotiation Specialist (REMOTE) to ensure accuracy and cost savings within our Workers' Compensation bill review process. This position is responsible for reviewing, auditing, and negotiating medical bills in compliance with state fee schedules and customer guidelines. The ideal candidate is detail-oriented, skilled in negotiations, and committed to providing excellent customer service while maintaining confidentiality and accuracy.

KEY RESPONSIBILITIES:

• Contact and negotiate with medical providers to secure additional savings through signed agreements.
• Review, audit, and process Workers' Compensation medical bills using industry-standard methodologies (Medicare, UCR, and state fee schedules).
• Maintain accurate records of negotiations and provider interactions.
• Research and interpret state fee schedules, customer guidelines, and regulations.
• Process reconsiderations and disputed bills in a timely and accurate manner.
• Provide high-quality customer service and resolve inquiries efficiently.
• Maintain strict confidentiality and compliance with company policies and industry regulations.
• Perform other related duties as assigned.

QUALIFICATIONS:

Education: High school diploma or equivalent required. Associate degree or higher preferred.

Experience:

• Minimum of 3 to 5 years of experience in medical bill review, with a minimum of 1 year of experience in customer service required. An equivalent combination of education and experience is required.
• Knowledge of CPT, ICD-10, and HCPCS coding required.
• Experience with Conduent Strataware software, or other comparable platforms, preferred.

Skills:

• Strong oral and written communication skills.
• Proven negotiation and customer service abilities.
• Proficient with Microsoft Office Suite and other computer applications.
• Excellent organizational skills with the ability to multi-task.
• Team player with strong interpersonal skills.
• Discretion, confidentiality, and attention to detail.

Licensing/Certification:

• Certification in medical coding or medical terminology preferred but not required.

WORKING CONDITIONS:

This position is 100% remote , with required availability during standard business hours. This role requires a dedicated workspace with reliable internet. The role involves prolonged periods of sitting, operating a computer, and communicating via phone and email.

Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristics.