Medical Payments Processor II

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’ve been around for more than  100 years, but don’t let that fool you. Pinnacol is committed to taking care of Colorado employers and workers in the most innovative ways. We celebrate continuous improvement, new ideas, compassion, teamwork, integrity and excellence.

With our number one priority to keep everyone safe, along with the heart of Pinnacol’s “culture of caring” to do what is right and not what is easy, we’re currently having our team members work from home. But we’re still making time for fun with virtual events like virtual painting classes, virtual yoga and Zumba classes, and virtual happy hours!

What you’ll do:

Review, validate, determine benefits payable in compliance with DOWC rules, and process medical and
other bills submitted on CMS 1500 and UB04 forms, as well as, various other bill forms.

What you can expect:

• Review bills for services related to injury ensuring cost containment and customer service for
company and policyholder
• Review all services to ensure billed charges are payable ensuring appropriate billing requirements
are met
• Verify accuracy of workers compensation fee schedule and PPO discount to bill to ensure proper
payment from Company
• Determine if additional bill review by other departments or other medical experts is needed; then
release pending bills returned by departments or medical experts
• Answer bill and rule related questions via phone and email with other departments and providers
when required
• Call provider for additional information in order to reduce re-bill requests
• Review previous processing of bill for consistent coding, accurate application of fee schedule and
PPO processing criteria to ensure proper payment
• Enter paper medical bills timely and accurately
• Correct and re-issue erroneous payments when received

What you need to be successful:

High School Degree or GED required. Completion of a degree is encouraged and supported. Six months
in medical claims processing required. Medical terminology, CPT code, Colorado Workers’
Compensation rules are strongly preferred and knowledge may be substituted for experience.

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.
• We love who you are. Pinnacol is on a journey to embody diversity, equity and inclusion. We’re committed to creating a culture that deeply values differences, where everyone feels like they belong.
• Take a day (or 20!) off. Enjoy 20 paid days off your first full year plus 9 paid holidays.
• 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 12 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, the skills and experience you bring, 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. The compensation amount for this role is targeted at $55,500 to $58,800. Final offer amounts are determined by multiple factors including your experience and expertise and may vary from the amounts listed above.

Want to love your work? Apply today!

Pinnacol is committed to working with and providing reasonable accommodations to applicants with disabilities. To request assistance with the application process, please email [email protected].

This posting will close 15 days after being published: October 23 2024