Bill Review Nurse

Responsibilities

• Reviews Facility and Professional bills as it compares with medical records, diagnosis & agreements for appropriateness or inconsistencies.
• Negotiates Pre-Surgical Services.
• Performs audits seeking potential leakage and/or system or procedural improvements.
• Provides professional advice and expertise to Claims staff in developing and providing medical and cost control procedures.
• Provides technical advice to lower-level associates and other functional areas.
• Assists with special projects as needed.
• May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.
• Performs other duties as assigned.
• The person hired for this position may work full-time remote depending on availability.

• Education:
  
  Bachelor’s degree in Healthcare Management, Nursing, or a related field.
• R.N. (Registered Nurse) required.
• Generally, a minimum of 14 years of case management or managed care experience.
• Expert knowledge of managed care laws and regulations.
• Advanced ability to identify and address nuanced details that may impact the effective management of a case.
• Demonstrated expert proficiency in organizing and prioritizing caseloads, ensuring timely completion.
• Excellent interpersonal and communication skills to collaborate with appropriate parties to ensure thorough and effective case management.
• Stays informed about emerging legislation and industry standards.
• Proven ability to handle confidential information with discretion.
• Advanced analytical skills with the ability to use data to analyze complex situations, identify problems, and develop effective solutions.
• Recognized as a subject matter expert on the team and in the organization.

Salary Range: $76,950.00 - $

• Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement.
• Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays.
• 401(k) plan with company match.
• Employee stock purchase plan.
• Commuter benefits.