RN Bill Review Specialist

Remote Co.; Lakeland (FL); On-site; USD 77,000 - 109,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Wellness plans

Parental leave

Adoption assistance

Tuition reimbursement

Paid time off

Paid holidays

401(k) with company match

Employee stock purchase plan

Commuter benefits

Job summary

SCI Summit Consulting, LLC seeks a Bill Review Nurse to oversee medical bill review and cost control within workers’ compensation. The role emphasizes expert case management, managed care compliance, and collaboration with Claims staff to optimize outcomes.

Requires a Bachelor’s degree in Healthcare Management or Nursing and RN licensure, with 14+ years of experience. On-site four days weekly, one remote day, with potential for full-time remote depending on availability.

Qualifications

• Bachelor's degree in Healthcare Management, Nursing, or related field.
• RN (Registered Nurse) required.
• Generally, a minimum of 14 years of case management or managed care experience.
• Expert knowledge of managed care laws and regulations.

Responsibilities

• Reviews Facility and Professional bills against medical records for appropriateness or inconsistencies.
• Negotiates Pre-Surgical Services.
• Performs audits to identify leakage and process improvements.
• Provides professional advice to Claims staff on medical and cost control procedures.
• Provides technical advice to lower-level associates and other areas.
• On-site four days a week with one remote day; potential full-time remote depending on availability.

Skills

Case management

Managed care knowledge

Analytical skills

Interpersonal communication

Subject matter expertise

Education

Bachelor's degree (Healthcare Management/Nursing)

RN required

Job description

SCI Summit Consulting, LLC seeks a Bill Review Nurse to oversee medical bill review and cost control within workers’ compensation. The role emphasizes expert case management, managed care compliance, and collaboration with Claims staff to optimize outcomes.

Requires a Bachelor’s degree in Healthcare Management or Nursing and RN licensure, with 14+ years of experience. On-site four days weekly, one remote day, with potential for full-time remote depending on availability.