Zenith is a team of Workers' Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers' Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional.

Under general supervision, the Analyst will be responsible to analyze, audit, review and/or make corrections to medical bills from providers to determine the appropriate reimbursement.

 

• Reviews Workers’ Compensation medical bills to ensure accurate and appropriate payment recommendations, according to State Fee schedules, guidelines and PPO Network pricing.
• Approves, modifies, and/or denies bills in accordance with state mandates and/or department guidelines.
• Reviews and interprets supporting documentation attached to medical billings, including review of claim information, to determine appropriate reimbursement.
• Audits and certifies potential duplicate bills and determines previous status of processing through close review and search of medical bills in the bill review system.
• Confirms and applies utilization review determinations as part of medical bill reviews when applicable.
• Determines and forwards bills to the MAT team that may be eligible for provider negotiations based on evaluation of billed services, pricing, and payment guidelines.
• Manages a bill processing assignment, which includes initial billing submissions. Tracks issues and trends.
• Occasionally processes bills requiring a secondary review, such as those submitted through the formal reconsideration process.
• Participates and completes required training to enhance the proficiency in bill review and processing.
• Communicates any system, bill review, billing anomaly and procedural issues to departmental supervisor.
• Meets established production and quality goals.
• Responds positively to direction and feedback on performance.
• Works productively and harmoniously with others on a consistent basis.
• Consistently maintains professional and appropriate demeanor.
• Performs other job related duties as assigned.

• High School Diploma or equivalent combination of education and experience required
• Bachelor’s Degree or equivalent combination of education and experience preferred

• 1-3 years medical bill review (or related) experience, in Workers Compensation, Medical/Health Care, Insurance Industry or Medical Coding/Billing. Work experience demonstrating knowledge of ICD-10 classifications, CPT codes, HCPCS, Workers' Compensation State Fee Schedules and/or Medicare knowledge required.

Demonstrated knowledge of medical terminology, anatomy and surgical/medical procedure terms.

Demonstrated proficiency with billing software, technology and system driven workflows.

Demonstrated familiarity with a broad type of medical billing forms.

Ability to interpret medical records to support the appropriate billed services.

Strong verbal and written communication skills.

Ability to work with little direction and maintain long periods of focused concentration.

Strong prioritization and time management skills.

Flexible and adaptable to a growing and changing environment.

All candidates must meet; or be able to obtain, as set forth within the statutory requirement, all state regulatory standards regarding certification, licensing, designation and continuing education requirements.

The expected salary range for this position is $43,996 - $54,995. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law. Qualifications may warrant placement in a different job level.

Benefits

• Medical, Dental and Vision Insurance
• Flexible Spending Accounts
• Paid Parental Leave
• Life, AD&D and Disability Insurance
• 401(k), Employee Share Purchase Plan (ESPP)
• Education and Training Reimbursement
• Paid Leave: 3 weeks/year Vacation, 2 weeks/year Sick Leave
• 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays
• Employee Assistance Program (EAP)
• For more information, review details on the Benefits page of our Career Site: https://www.thezenith.com/careers/benefits/

Zenith typically posts jobs for a minimum of 8 to 14 calendar days. If you are interested in any of our open positions, we encourage you to submit your application promptly.

Zenith Insurance Company is an equal opportunity employer and considers all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristic. In compliance with California law, we are committed to fair hiring practices. Pursuant to the California Fair Chance Act (AB 1008), we will consider qualified applicants with criminal histories in a manner consistent with the law. Additionally, in accordance with the Los Angeles Fair Chance Initiative for Hiring Ordinance, we will not inquire about an applicant’s criminal history until after a conditional offer of employment has been made.

If you are a qualified individual with a disability or a disabled veteran and need assistance accessing our career center or applying for a position due to your disability, you are entitled to request an accommodation. To make a request, please contact a Human resources representative at Zenith Insurance Company.

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