Medical Bill Review Senior Nurse

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Medical Bill Review Senior Nurse

127127

Zurich Insurance is currently looking for a Medical Bill Review Senior Nurse to work from our Schaumburg, IL office. 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 Zurich´s 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
• Regular Predictable Attendance

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.

Basic Qualifications

• Bachelor’s 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
• Customer service experience
• 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
• Strong communication skills
• Fundamental knowledge of insurance industry, claims, and the insurance legal and regulatory environment preferred
• Strong problem solving skills
• Ability to collaborate across work groups

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.

A future with Zurich. What can go right when you apply at Zurich?

Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here to learn more.

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 - Georgia Virtual Office, AM - Schaumburg

Remote Working: Hybrid

Schedule: Full Time

Employment Sponsorship Offered: No

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