Bill Review Nurse

Summit Insurance Group, Inc.•Lakeland, FL

1d•Remote

About The Position

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. The person hired for this position may work full-time remote depending on availability.

Requirements

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.
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.

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.