Title: Medical Bill Review Nurse I
Location: Virtual, AZ, US +12 more
With moderate direction, reviews complex medical billing 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 compensational injury, to maximize the benefits to the claimant while ensuring appropriate costs to the carrier.
- 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.
- Escalate questions by engaging senior Medical Bill Review Specialty Nurse for assistance.
- Ensure customer satisfaction by responding to customer inquiries quickly, accurately and in a professional manner.
- Meet quality standards by adhering to Best Practices.
- Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
- Protect Zurichs 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.
- Bachelors Degree and 2 or more years of experience in the Critical Care Unit or Emergency Room or Medical Billing 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 Billing or Medical Surgical Facility or Operating Room area
Current Registered Professional Nurse license
• Microsoft Office experience
- 1 or more years’ experience in utilization review, nurse case management, workers compensation, medical bill review, coding Certification(s) in any of the above
- Strong communication skills
Applicable Only to Jobs to be Performed in Remotely in any US State
The salary range for this role is $64,600.00 to $84,700.00. This is the range Zurich NA in good faith believes is the range of possible compensation for this role at the time of the posting. Zurich NA may ultimately pay more or less than the posted range and this range is only applicable for jobs to be performed remotely in any US state. This range may be modified in the future. This job is also bonus eligible. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable.
As a condition of employment at Zurich, employees must adhere to our COVID-related health and safety protocols (https://www.zurichna.com/careers/faq), including, without limitation, a requirement that employees attest as to their vaccination status with a YES/NO, and upload proof of vaccination status, or a negative COVID test result when applicable, to a third-party vendor. These protocols are continuously re-evaluated and the requirements may change at any time.
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.
As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet
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 – Arizona Virtual Office, AM – Atlanta, AM – California Virtual Office, AM – Chicago, AM – Dallas, AM – Georgia Virtual Office, AM – Overland Park, AM – Owings Mills, AM – Parsippany, AM – Philadelphia, AM – Rancho Cordova, AM – Remote Work (US), AM – Schaumburg
Remote Working: Yes
Schedule: Full Time
Linkedin Recruiter Tag: #LI-LC1