Medical Bill Review Senior Nurse

Zurich Insurance • Schaumburg, IL

124d • $71,100 - $116,500 • Remote

About The Position

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.

Requirements

• 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.
• Current Registered Professional Nurse license.
• Customer service experience.
• Knowledge of CPT and ICD-9 and ICD-10 codes and medical terminology.

Nice To Haves

• 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.

Responsibilities

• 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.

Benefits

• Competitive compensation.
• Short-term incentive bonuses and merit increases.
• Comprehensive employee benefits package for employees and eligible dependents.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree