Nurse Medical Bill Auditor

This role is eligible to participate in Zenith’s hybrid work schedule which provides the flexibility to work from home on select days of the week according to the in-office schedule established by regional executive leadership.

This position can be filled in ANY Zenith Branch

Responsible for clinical review and analysis and appropriate adjustment of billing as needed based on Workers Compensation fee schedules and guidelines or other jurisdictional pricing applications. Uses independent judgment to negotiate and communicate with medical providers to obtain the best outcome. Assists management in identifying areas of opportunity based on current medical billing environments. Provides written and verbal interpretation of reviews if a contested case goes to trial.

Partners with effective interaction with claims and claims legal. May involve assisting with special projects.

The essential functions of this position include, but are not limited to, the following:

• Analyzes and audits medical bills from multiple states in order to verify, adjust, or recommend payment in accordance with state fee schedules, coding guidelines, healthcare regulations and medical compliance.
• Monitors billing for trends.
• Communicates with providers regarding disputed claims and payments.
• Ensures an ongoing working relationship with providers.
• Advises Legal department on fee schedule guidelines, billing rules and medical compliance/standards.
• Consults Legal on bill reimbursement and state appeals.
• Evaluates and negotiates high dollar bills that have the potential for significant savings and/or reconcile outstanding provider balances to mutual satisfaction.
• Represents the company at the state level when involved with workshops, state appeals, hearing disputes, and legislative hearings.
• Provides resources to Bill Review analysts and management for special projects, training, and reports.
• Advocate a collaborative working relationship with claims and advise on particular bills or payment strategies.
• Performs other job-related duties as assigned.
• Professional Development.
• Maintains clear and active license in state(s) employed.
• Pursues continuing education to maintain licensure active status, in technical areas related to Workers´ Compensation injuries, illnesses and bill auditing.
• Possesses or pursues additional professional designations such as coding certifications from AHIMA/AAPC/CMAS.
• Maintains strong written and verbal communication and negotiation skills.
• Works productively and harmoniously with others on a consistent basis.
• Responds positively to direction and feedback on performance.
• Consistently maintain professional and appropriate demeanor.
• Perform other duties/projects as assigned.

Education Qualifications

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

Experience Qualifications

• 4+ Years of clinical experience in Orthopedics, ER, Occupational Health and/or Neurology/Neurosurgery required

Skills and Abilities

• Active and clear RN with extensive, relevant coding and bill auditing experience.
• Experience with/understanding of utilization/bill review, claims, managed care processing;
  Workers´ Compensation Bill Audit experience, including knowledge of workers´ compensation laws/fee schedules in most states, preferred.
• Excellent negotiation, problem solving and analytical skills and strategies.
• Excellent interpersonal and communication skills - oral and written.
• Must be able to communicate effectively with all levels of staff.
• Experience with Windows (3.1 or higher), Microsoft Office, and Excel.

The expected salary range for this position is $77,942.10 to $97,427.63. 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…