Medical Bill Review Senior Nurse

Zurich Insurance Company Ltd.•Schaumburg, IL

45d•Hybrid

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. 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.

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
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
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

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.
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.
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.