Zurich 56 Company Ltd
Medical Bill Review Senior Nurse
Zurich 56 Company Ltd, Oregon, Illinois, United States, 61061
Overview
Medical Bill Review Senior Nurse
is a position based in Schaumburg, IL. With limited direction, reviews highly complex medical billing, including more difficult medical jurisdictions, to ensure relatedness and compliance with regional, country and/or local regulations and applicable coding guidelines, and contractual agreements. Determines the medical charges according to fairness and reasonableness for a compensable injury, to maximize the benefits to the claimant while ensuring appropriate costs to the carrier. Key Accountabilities
Manage medical bill litigation, research, and resolve issues by working with corporate law, Technical Claims and other, as necessary. Prepare, attend and participate in any medical bill hearings or depositions, as necessary. Apply medical knowledge by validating the appropriateness of medical treatment and medical bill charges against compensable injury. Follow Best Practices and exercise judgment by accurately reviewing medical bills within appropriate time frame for regional, country and/or local jurisdiction. Assist in the identification of fraudulent billings by reporting suspicious activity to Special Investigations Unit. Resolve escalated issues by exercising judgment, applying medical expertise and referring to policies, procedures and specifications. Ensure customer satisfaction by responding to customer inquiries quickly, accurately and in a professional manner. Meet quality standards by adhering to Best Practices and participating in monthly peer review audits. Ensure legal compliance by following regional, country and/or local laws and regulations and internal control requirements. Improve accuracy and timeliness of services by identifying problems, providing creative recommendations for procedural and process improvements, and supporting the implementation of customer initiatives. Provide customer service by recognizing and responding to the needs of business partners and providing status updates. Serve as a technical subject matter expert by assisting with training and mentoring lower level Specialty Nurses and sharing technical knowledge. Protect Zurichs reputation by keeping claims information confidential. Maintain professional certifications and technical knowledge by participating in educational opportunities, staying current with industry trends, and establishing personal networks. Contribute to the team effort by accomplishing related results and participating on projects as needed. Business Travel, as required Extended Hours during Peak Periods, as required Maintain a Valid Driver's License, as required Pass Applicable Exam/Licensing, as required Business Accountabilities
Anticipate, recognize and respond timely to needs of customers to ensure customer satisfaction. Respond to inquiries quickly and completely, provide status updates to ensure customer satisfaction. Review assigned medical bills, apply technical insights, applying discretion within authority limits in order to resolve billing issues. Input relevant data into established systems accurately so that analysis can be undertaken. Support implementation of bill review initiatives to drive continuous improvement of operational efficiencies and quality. Identify and follow main principles relevant to legal and regulatory controls that govern standard work practices to ensure compliance. Monitor and review complex billing information, updating where necessary in order to identify any anomalies or discrepancies and ensure management has access to up-to-date and accurate information to understand medical bill review performance. Mentor lower level medical bill review staff and seek out resources to resolve performance issues to fulfill the customer proposition. Performance Management Accountabilities
Model behaviors that demonstrate commitment to corporate values. Provide input into performance management discussions of project team members. Educate team members and business partners on area of technical expertise. Provide guidance and support for team members. Take action to manage own personal development and encourage others to do the same. Qualifications
Bachelors Degree and 2 or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or Operating Room area OR Associate Degree and 4 or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or Operating Room area AND Current Registered Professional Nurse license Knowledge of CPT and ICD-9 and ICD-10 codes and medical terminology Preferred Qualifications
2 or more years experience in Utilization Review, Case Management, Workers Compensation, or medical bill reviews Fundamental knowledge of insurance industry, claims, and the insurance legal and regulatory environment preferred Ability to collaborate across work groups Compensation and Benefits
At Zurich, compensation for roles is influenced by a variety of factors, including but not limited to the specific office location, role, skill set, and level of experience. In compliance with local laws, Zurich commits to providing a fair and reasonable compensation range for each role. For more information about our Total Rewards, please click here. Additional rewards may encompass short-term incentive bonuses and merit increases. We encourage candidates with salary expectations beyond the provided range to apply as they will be considered based on their experience, skills, and education. The compensation indicated represents a nationwide market range and has not been adjusted for geographic differentials pertaining to the location where the position may be filled. The proposed salary range for this position is $71,100.00 - $116,500.00, with short-term incentive bonus eligibility set at 10%. As an insurance company, Zurich is subject to 18 U.S. Code 1033. Company Overview and Equal Opportunity
Zurich in North America is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. Location(s): AM - Schaumburg; Remote Working: Hybrid; Schedule: Full Time; Employment Sponsorship Offered:No. Linkedin Recruiter Tag: #LI-JJ1 #LI-ASSOCIATE #LI-HYBRID #J-18808-Ljbffr
Medical Bill Review Senior Nurse
is a position based in Schaumburg, IL. With limited direction, reviews highly complex medical billing, including more difficult medical jurisdictions, to ensure relatedness and compliance with regional, country and/or local regulations and applicable coding guidelines, and contractual agreements. Determines the medical charges according to fairness and reasonableness for a compensable injury, to maximize the benefits to the claimant while ensuring appropriate costs to the carrier. Key Accountabilities
Manage medical bill litigation, research, and resolve issues by working with corporate law, Technical Claims and other, as necessary. Prepare, attend and participate in any medical bill hearings or depositions, as necessary. Apply medical knowledge by validating the appropriateness of medical treatment and medical bill charges against compensable injury. Follow Best Practices and exercise judgment by accurately reviewing medical bills within appropriate time frame for regional, country and/or local jurisdiction. Assist in the identification of fraudulent billings by reporting suspicious activity to Special Investigations Unit. Resolve escalated issues by exercising judgment, applying medical expertise and referring to policies, procedures and specifications. Ensure customer satisfaction by responding to customer inquiries quickly, accurately and in a professional manner. Meet quality standards by adhering to Best Practices and participating in monthly peer review audits. Ensure legal compliance by following regional, country and/or local laws and regulations and internal control requirements. Improve accuracy and timeliness of services by identifying problems, providing creative recommendations for procedural and process improvements, and supporting the implementation of customer initiatives. Provide customer service by recognizing and responding to the needs of business partners and providing status updates. Serve as a technical subject matter expert by assisting with training and mentoring lower level Specialty Nurses and sharing technical knowledge. Protect Zurichs reputation by keeping claims information confidential. Maintain professional certifications and technical knowledge by participating in educational opportunities, staying current with industry trends, and establishing personal networks. Contribute to the team effort by accomplishing related results and participating on projects as needed. Business Travel, as required Extended Hours during Peak Periods, as required Maintain a Valid Driver's License, as required Pass Applicable Exam/Licensing, as required Business Accountabilities
Anticipate, recognize and respond timely to needs of customers to ensure customer satisfaction. Respond to inquiries quickly and completely, provide status updates to ensure customer satisfaction. Review assigned medical bills, apply technical insights, applying discretion within authority limits in order to resolve billing issues. Input relevant data into established systems accurately so that analysis can be undertaken. Support implementation of bill review initiatives to drive continuous improvement of operational efficiencies and quality. Identify and follow main principles relevant to legal and regulatory controls that govern standard work practices to ensure compliance. Monitor and review complex billing information, updating where necessary in order to identify any anomalies or discrepancies and ensure management has access to up-to-date and accurate information to understand medical bill review performance. Mentor lower level medical bill review staff and seek out resources to resolve performance issues to fulfill the customer proposition. Performance Management Accountabilities
Model behaviors that demonstrate commitment to corporate values. Provide input into performance management discussions of project team members. Educate team members and business partners on area of technical expertise. Provide guidance and support for team members. Take action to manage own personal development and encourage others to do the same. Qualifications
Bachelors Degree and 2 or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or Operating Room area OR Associate Degree and 4 or more years of experience in the Critical Care Unit or Emergency Room or Medical Surgical Facility or Operating Room area AND Current Registered Professional Nurse license Knowledge of CPT and ICD-9 and ICD-10 codes and medical terminology Preferred Qualifications
2 or more years experience in Utilization Review, Case Management, Workers Compensation, or medical bill reviews Fundamental knowledge of insurance industry, claims, and the insurance legal and regulatory environment preferred Ability to collaborate across work groups Compensation and Benefits
At Zurich, compensation for roles is influenced by a variety of factors, including but not limited to the specific office location, role, skill set, and level of experience. In compliance with local laws, Zurich commits to providing a fair and reasonable compensation range for each role. For more information about our Total Rewards, please click here. Additional rewards may encompass short-term incentive bonuses and merit increases. We encourage candidates with salary expectations beyond the provided range to apply as they will be considered based on their experience, skills, and education. The compensation indicated represents a nationwide market range and has not been adjusted for geographic differentials pertaining to the location where the position may be filled. The proposed salary range for this position is $71,100.00 - $116,500.00, with short-term incentive bonus eligibility set at 10%. As an insurance company, Zurich is subject to 18 U.S. Code 1033. Company Overview and Equal Opportunity
Zurich in North America is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. Location(s): AM - Schaumburg; Remote Working: Hybrid; Schedule: Full Time; Employment Sponsorship Offered:No. Linkedin Recruiter Tag: #LI-JJ1 #LI-ASSOCIATE #LI-HYBRID #J-18808-Ljbffr