Medical Fee Examiner

Job Code: 32000610
Salary Grade: MH09
Revision Date: 06/2018

Class Concept

This is professional work of supervising the examination of all medical bills submitted for medical treatment and other medical services rendered in accordance with the North Carolina Workers' Compensation Act. Employees are responsible for independently researching, developing, and implementing the Medical Fee Schedule. Guidance is received from a Medical Advisory Committee and the medical community. Employees make decisions on unusual or complicated fee matters not previously submitted or established as a policy.

Recruitment Requirements

Knowledge, Skills, and Abilities

• Thorough knowledge of the North Carolina Workers' Compensation Act and development of a Medical Fee schedule, and ability to apply the provisions of these.
• Considerable knowledge of medical terminology and hospital and operating room procedures.
• Considerable knowledge of medical, surgical, or hospital services provided for a variety of industrial accidents or injuries.
• Ability to apply the provisions of the Industrial Commission medical fee schedule.
• Ability to express oneself clearly and concisely in oral and written form.
• Ability to maintain favorable working relationships with other members of the department.
• Ability to consult with physicians, hospitals and other medical providers.
• Ability to supervise the work of others and manage an office. Good math skills.

Minimum Education and Experience

High school or General Educational Development diploma and four years of experience in a hospital, clinic, insurance company, or private organization involved in determining charges for professional medical services or hospitalization; or Graduation from a state accredited nursing program, one year of general nursing experience, and one year of experience in determining charges for professional medical services or hospitalization; or an equivalent combination of education and experience.