Workaholics4Hire.com

Location: Work from home

Medical Bill Review Nurse – part time

Date: 2010-03-19, 11:33AM PDT

Medical Bill Review Nurse (part time)

Flexible hours, work from home potential

Job Summary: Under the direct supervision of the Director of Cost Containment Services is responsible for retrospective review of rendered inpatient and outpatient health care services for medical necessity, up-coding, unbundling and appropriateness. Interaction with the respective department staff.

Responsibilities:
- Review of Workers’ Compensation medical bills – Determination the accurateness and appropriateness for the diagnosis and/or request additional documentation to approve or deny the bill.
- Determine procedure performed is supported by the documentation.
- Verify the level of CPT coding corresponds with the documentation and is a worker’s compensation injury.
- Determine the appropriateness to re-price according to State Fee Schedule/Guidelines – Handle Workers’ Compensation medical bill review dispute process -Documents review summaries in system and completes all fields appropriately, including the rationale and criteria used for each denial decision.
- Maintain turn-around times guaranteed to individual clients -Problem Solving, Analytical Ability, Communication Skills, and Interpersonal Skills are important factors to successful performance in this position.

Requirements:
Qualified candidate will possess the following:
- RN from an accredited hospital program, college or university is required – Current and active RN license is required – Working knowledge of current medical terminology, treatment modalities, diagnostic studies, medications and additional services rendered by multiple providers – Working knowledge of Worker’s Compensation fee guidelines is required – Working knowledge of ICD-9 and CPT coding, with medical bill processing and or review experience is required.
- Background in workers compensation and/or occupational health (minimum of 2 years)
- 2 years of clinical experience preferred, but not required
- Ability to use Windows Software
- Excellent organizational, telephonic and written communication skills

* Compensation: based on experience
* This is a part-time job.
* Principals only. Recruiters, please don’t contact this job poster.
* Please, no phone calls about this job!
* Please do not contact job poster about other services, products or commercial interests.

[W4H Note: This is posted on an Orange County, CA list.]

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