Bill Review Nurse

Great American Insurance Group; Gainesville (GA); Hybrid; USD 77,000 - 109,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness plans

Parental leave

Tuition reimbursement

Paid time off

Job summary

Summit Consulting seeks a skilled Registered Nurse with strong case management and managed care experience to review and optimize workers' compensation claims. The role involves auditing medical bills, advising on cost-control procedures, and supporting claims staff across a range of cases.

The position requires a Bachelor's degree in Healthcare Management or Nursing and an active RN license, with four days on-site and one remote day.

Qualifications

• Bachelor's degree in Healthcare Management or Nursing is required.
• RN license or current registration is required.
• Minimum years of case management or managed care experience is indicated.

Responsibilities

• Reviews Facility and Professional bills against medical records and diagnoses for appropriateness.
• Negotiates Pre-Surgical Services.
• Performs audits to identify leakage and process improvements.
• Provides expert advice to Claims staff on medical and cost-control procedures.
• Mentors staff and may participate in talent selection and performance reviews.
• May lead special projects and assist with other duties as assigned.

Skills

RN

Case management

Managed care

Data analysis

Education

Bachelor's degree in Healthcare Management or Nursing

RN license

Job description

Bill Review Nurse page is loaded## Bill Review Nurseremote type: Remotelocations: Lakeland, FL (USA): Gainesville, GA (USA)time type: Full timeposted on: Posted 5 Days Agojob requisition id: R9631Summit 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.* **The person hired for this position may work full-time remote depending on availability.**#LI-Hybrid**Job Requirements**### **Education:** **Bachelor's degree in Healthcare Management, Nursing, or a related field. R.N. (Registered Nurse) required.**###### **Experience:** 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.**Company:**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 .**\\*Excludes seasonal employees and interns.**remote type: Hybridlocations: Gainesville, GA (USA)time type: Full timeposted on: Posted 6 Days AgoSummit 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. We provide independent insurance agents and their clients with market-leading workers' comp insurance and elite customer service.Currently serving more than 7,000 independent agents and 31,000 policyholders across 17 states in the South, Midwest, and Mid-Atlantic, we're growing with more states coming soon.Our strength comes from a single-minded 100% focus on workers' comp and a commitment to long-term customer relationships. We're not a faceless corporation with distant headquarters. Field team members reside in every state in which we operate and are part of the fabric of local communities.As the world becomes increasingly impersonal, Summit offers a customer experience based on relationships and personal service. You'll always be able to speak to a real human being. You'll always receive timely answers you can trust.Insurance agents, policyholders, and injured employees can count on three things:1) More Access. Our team members are not only masters in the field but they're easy to reach and highly responsive when you need answers.2) More Know-how. You'll get better answers from real experts and industry veterans who know workers' comp, your business, your customers, and your region.3) More Commitment. You'll have collaborators who go the extra mile to serve you and who are willing to solve problems that others usually can't.Summit is a member of Great American Insurance Group and a subsidiary of American Financial Group, Inc (AFG). AFG's common stock is listed and traded on the New York Stock Exchange under the symbol AFG.