Registered Nurse Bill Review

Job Summary

To support a growing team, the full-time remote Registered Nurse Bill Review will review facility and professional bills for accuracy, negotiate pre-surgical services, and provide expertise to claims staff while ensuring compliance with managed care regulations.

Key responsibilities

• Reviews bills against medical records and agreements for appropriateness and inconsistencies
• Negotiates pre-surgical services and performs audits to identify potential leakage and procedural improvements
• Provides professional advice and technical support to claims staff and assists with special projects as needed

Required qualifications

• Bachelor's degree in Healthcare Management, Nursing, or a related field; R.N. required
• Minimum of 14 years of case management or managed care experience
• Expert knowledge of managed care laws and regulations
• Advanced analytical skills with the ability to use data for problem-solving
• Recognized as a subject matter expert within the organization