Bill Review Nurse
HybridLakeland, Florida, United States
Job Summary
Review facility and professional bills against medical records for appropriateness and inconsistencies. Negotiate pre-surgical services and perform audits to identify leakage or procedural improvements. Provide technical advice to claims staff on cost control procedures and mentor lower-level associates on case management. Assist with special projects and may supervise staff performance and talent selection. Work full-time remotely with hybrid availability options. This role requires a Registered Nurse with at least 14 years of managed care experience to support Summit's focus on workers' comp specialists serving thousands of independent agents and policyholders across the South, Midwest, and Mid-Atlantic.
Required Qualifications
- Applicants must be authorized to work in the United States without the need for current or future sponsorship
- 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
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