Medical Payment Processor II - Utilization Review

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:

You will work closely with  a team responsible for building a new program at Pinnacol designed to help ensure injured workers receive the right care at the right time. Key areas of focus include identifying and processing bills within the new Utilization Review (UR) program. Collaborates with Utilization Review Coordinator to ensure that approved and denied services are paid appropriately. Supports and participates in a transition toward increasing UR efficiency and automation by taking advantage of new software that streamlines workflows and helps manage information and communication.  Additionally, you will review, validate, determine benefits payable in compliance with DOWC rules, and process medical and other bills submitted on CMS 1500, UB04 and other bill forms.

What you can expect:

• Meets processing productivity, quality, and time service metrics 
• Reviews and validates bills, and determines benefits payable in compliance with DOWC rules and MedPay procedures 
• Follows Standard Work for all job functions
• Refers and/or escalates complex bills and/or calls per procedures 
• Adheres to all DOWC rules and regulations, applicable HIPAA regulations, and accurately applies PPO contract language while processing and during all inbound and outbound calls
• Meets all internal and external service level agreements to ensure timely bill payments, follow-ups, and superior customer service
• Provides best in class customer service to all internal and external customers
• Meets all internal and external service level agreements to ensure timely data entry, Tier 1 bill payments, follow-ups, and superior customer service
• Perform other duties as assigned 
• Contributes to continuous improvement to processes and procedures
• Serves on special assignments/steering committees/project teams as requested

What you need to be successful:

• High school diploma or equivalent is required. Bachelor's degree is preferred
• A minimum of six months in medical claims processing (preferred)
• Relevant work experience and/or coding certification may be substituted for education and/or experience requirements
• Expertise/education in medical terminology, CPT/ICD coding, Colorado Workers’ Compensation rules (preferred)
• Ability to come into the office at least 3-4 times per week

• 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 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, 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 $25.00-$26.35/hr. 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].