Nurse – Medical Bill Auditor
Zenith Insurance Company (United States)
full-time
Posted on:
Location Type: Hybrid
Location: Woodland Hills • California • Florida • United States
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Salary
💰 $77,942 - $97,428 per year
About the role
- 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.
- 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.
- 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.
Requirements
- High School Diploma or equivalent combination of education and experience required
- Bachelor’s Degree or equivalent combination of education and experience required
- 4+ years of clinical experience in Orthopedics, ER, Occupational Health and/or similar specialty fields
- 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.
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 Days, 2 Floating Holidays
- Employee Assistance Program (EAP)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical reviewbilling adjustmentmedical billing analysiscoding guidelinesbill auditingnegotiation strategiesutilization reviewclaims processingWorkers' Compensation lawsmedical compliance
Soft Skills
communication skillsnegotiation skillsproblem solvinganalytical skillsinterpersonal skillscollaborationadaptabilityprofessional demeanorfeedback responsivenesstraining and mentoring
Certifications
RN licensecoding certificationsAHIMA certificationAAPC certificationCMAS certification