Nurse Med Bill Auditor (6436)

Zenith Insurance Company•Los Angeles, CA

About The Position

Zenith is a team of Workers' Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers' Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional. Overview Responsible for clinical review and analysis and appropriate adjustment of billing as needed based on Workers Compensation fee schedules and guidelines or other jurisdictional pricing applications. Uses independent judgment to negotiate and communicate with medical providers to obtain the best outcome. Assists management in identifying areas of opportunity based on current medical billing environments. Provides written and verbal interpretation of reviews if a contested case goes to trial. Partners with effective interaction with claims and claims legal. May involve assisting with special projects.

Requirements

High School Diploma or equivalent combination of education and experience Req
Bachelor’s Degree or equivalent combination of education and experience Req
4+ years of clinical experience in Orthopedics, ER, Occupational Health and/or similar specialty fields.
Active and clear RN with extensive, relevant coding and bill auditing experience.
Experience with/understanding of utilization/bill review, claims, managed care processing; Workers´ Compensation Bill Audit experience, including knowledge of workers´ compensation laws/fee schedules in most states, preferred.
Excellent negotiation, problem solving and analytical skills and strategies.
Excellent interpersonal and communication skills - oral and written.
Must be able to communicate effectively with all levels of staff.
Experience with Windows (3.1 or higher), Microsoft Office, and Excel.

Responsibilities

Analyzes and audits medical bills from multiple states in order to verify, adjust, or recommend payment in accordance with state fee schedules, coding guidelines, healthcare regulations and medical compliance.
Monitors billing for trends.
Communicates with providers regarding disputed claims and payments.
Ensures an ongoing working relationship with providers.
Advises Legal department on fee schedule guidelines, billing rules and medical compliance/standards.
Consults Legal on bill reimbursement and state appeals.
Evaluates and negotiates high dollar bills that have the potential for significant savings and/or reconcile outstanding provider balances to mutual satisfaction.
Represents the company at the state level when involved with workshops, state appeals, hearing disputes, and legislative hearings.
Provides resources to Bill Review analysts and management for special projects, training, and reports.
Advocate a collaborative working relationship with claims and advise on particular bills or payment strategies.
Performs other job related duties as assigned.
Maintains clear and active license in state(s) employed.
Pursues continuing education to maintain licensure active status, in technical areas related to Workers´ Compensation injuries, illnesses and bill auditing.
Possesses or pursues additional professional designations such as coding certifications from AHIMA/AAPC/CMAS.
Maintains strong written and verbal communication and negotiation skills.
Works productively and harmoniously with others on a consistent basis.
Responds positively to direction and feedback on performance.
Consistently maintain professional and appropriate demeanor.
Perform other duties/projects as assigned.