Bill Review Complex Analyst, Risk Management – Lakeland

Location: Lakeland, FL
Job ID: 31755BR
Department: Risk Management
Working Hours: Monday - Friday, 8:00am - 4:30pm
Pay Frequency: Weekly
Date Posted: Feb 03, 2025

$40 - 56k

Hybrid

Full Time - Regular

Apply

---

Description

The purpose of this position is to analyze and review medical bills for adjudication of invoices for Publix associates injured in Workers Compensation accidents. The Bill Review Analyst is responsible for ensuring bills are paid in a timely manner and in accordance with the Workers Compensation laws of the states in which Publix does business in.
Responsibilities:

• Reviewing and analyzing medical bills to confirm whether treatment rendered was authorized by the adjuster or medical case manager is appropriate for the type of injury sustained, and that the fees invoiced are standard and equitable, follow appropriate schedules and regulations, and align with previous contracted agreements
• Manually reviewing and resolving issues on medical bills that are flagged as requiring more in-depth review, or which cannot otherwise be re-priced to the appropriate state workers’ compensation fee schedule by our automated medical bill review system
• Communicating directly with vendors and medical providers that challenge the amount reimbursed
• Provide customer service to providers, Publix managers, and associates that contact Risk Management regarding the payment or non-payment of bills

---

Required Qualifications

• Associate’s degree or equivalent experience
• 1 year general office experience with Windows based programs
• Knowledge of CPT and ICD-9 codes
• Knowledge of multiple state Worker’s Compensation Fee Schedules for the states in which Publix does business in
• Knowledge of Medical Terminology
• Ability to self-direct work activities and take action on tasks without direction from a supervisor
• Ability to set priorities, plan and coordinate work activities, schedule staff, and obtain and manage resources so that work objectives are accomplished on time and within budget.
• Ability to work productively and effectively when faced with stressful work situations and time pressures
• Ability to manage time so that the priority of the activities determines the timing and amount of attention they receive
• Ability to interpret, analyze, and explain financial information
• Strong attention to detail
• Ability to effectively resolve problems
• The ability to develop and maintain professional, trusting, positive, and productive working relationships with associates, managers, customers, and vendors
• Ability to create an environment in which a positive and professional service orientation is evident to internal customers
• Excellent verbal and written communication
• Basic skills in Microsoft Word, Excel, PowerPoint, and Access
• Availability to work occasional weekends, holidays, and extended hours

---

Preferred Qualifications

• Bachelor’s degree or certificate of completion of a medical terminology or medical billing program
• 1 year in medical or insurance services, with advanced knowledge of CPT and ICD-9 codes, and knowledge of medical terminology
• National Certification for CPT Coding
• Bilingual in English and Spanish
• Advanced skills in Microsoft Word, Excel, and Access
• Intermediate skills in Microsoft PowerPoint
• Experience with SmartAdvisor/CEPV, ODG, and Mitchell and RMX software systems

---

Benefits

• Employee stock ownership plan that contributes Publix stock to associates each year at no cost
• An opportunity to purchase additional shares of our privately-held stock
• 401(k) retirement savings plan
• Group health, dental and vision plans
• Paid Time Off
• Paid Parental Leave
• Short- and long-term disability insurance
• Tuition reimbursement
• Free hot lunches (buffet-style) at facilities with a cafeteria
• Visit our website to see all of our benefits: Benefits – Jobs (publix.com)

---

Year End Bonus

To reward associates for their contributions to the company for the calendar year, Publix provides a Holiday Bonus in November. In the first year of continuous employment the bonus is equal to 15 hours of pay, and in the second year of continuous employment the bonus is equal to one week’s pay if associate remains employed through issue date of the bonus check. In subsequent years, the bonus is equal to two weeks’ pay.

---

Additional Information

Your application may have additional steps that you will need to complete in order to remain eligible for consideration. Please be sure to monitor your email, including your spam folder, on a daily basis for critical, time-sensitive emails that could require action within 24-48 hours.

Please do not use your Publix email address when applying. Once your application has been successfully submitted you will receive a confirmation email.

For this position, Publix does not and will not file a petition or application with the USCIS or Department of State on behalf of any noncitizen for any immigration-related benefit to work and/or to continue to work in the United States, e.g., an H-1B or TN petition or permanent residence.

---