Bill Review Nurse

Summit; Gainesville (GA); Hybrid; USD 77,000 - 109,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) with company match

Paid time off and holidays

Tuition reimbursement

Commuter benefits

Job summary

SCI Summit Consulting, LLC is seeking a Registered Nurse with extensive case management and managed care experience to review medical bills, negotiate services, and drive cost controls. The role emphasizes expert knowledge of managed care laws and strong analytical skills, with on-site four days a week and one remote day depending on business needs.

The ideal candidate has a Bachelor’s in Healthcare Management or related field, plus 14+ years in the arena.

Qualifications

• RN is required and healthcare degree is essential.
• At least 14 years in case management or managed care.
• Expert knowledge of managed care laws/regulations.
• Strong analytical skills to use data for decisions.

Responsibilities

• Reviews facility and professional bills against records for accuracy.
• Negotiates Pre-Surgical Services.
• Performs audits to identify leakage and process improvements.
• Provides expert advice to Claims staff on medical and cost controls.
• Mentors lower-level staff and may participate in talent decisions.
• On-site four days a week with one day remote; remote work possible.

Skills

Bill Review

Communication

Managed Care

Education

Bachelor's in Healthcare Management

Registered Nurse (RN)

Job description

SCI Summit Consulting, LLC

Summit provides independent insurance agents and their clients with market-leading workers’ comp insurance and elite customer service. We’re growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic.

Our strength comes from a single-minded focus on workers’ comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers’ comp but also gets to know your business and your priorities.

Our field team members are located in every state in which we operate.

Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best.

This position is not eligible for employment visa sponsorship. Applicants must be authorized to work in the United States without the need for current or future sponsorship.

Essential Job Functions And 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.
• Great American’s culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in-office days are Tuesday–Thursday, with the fourth day determined by business needs.
• Must have bill review experience.
• The person hired for this position may work full-time remote depending on availability.

Job Requirements

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.

Scope of Job/Qualifications: 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.

SCI Summit Consulting, LLC

Salary Range

$76,950.00 -$108,870.00

Benefits

We offer competitive benefits packages for full-time and part-time employees*. 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, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.

• Excludes seasonal employees and interns.