Bill Review Nurse
Core
Reviews medical bills against records and diagnoses, negotiates pre-surgical services, and audits for leakage to control costs in workers' comp cases.
Role type
Senior Bill Review Nurse (Workers' Comp)
Builds
Cost control procedures and audit findings for insurance claims
Domain
Insurance / Workers' Compensation
Required skills
Medical bill review, Pre-surgical negotiation, Auditing for leakage, Managed care law expertise, Case prioritization, Data analysis
Preferred skills
Staff coaching, Talent selection input, Emerging legislation tracking
Technologies
Medical records systems, Data analysis tools
Responsibilities
Compare facility and professional bills with medical records and diagnoses, Negotiate pre-surgical services, Perform audits to identify leakage and procedural improvements, Provide technical advice to claims staff on cost control, Assist with special projects
Seniority
Senior, hands-on IC with potential mentorship
