Review/analyze the medical documentation, submitted with Workers’ Compensation bills, and determine if they meet the level of care/services billed. Utilizing resources available and applying clinical expertise to reduce medical reimbursement above and beyond State Fee Schedules and PPO. Communicating with providers and client legal teams, both written and orally, may be necessary in supporting clinical reductions on medical billing. This position is within a production environment and must meet or exceed established standards.

Duties / Responsibilities

• Review/analyze the medical documentation submitted and determine if it meets the level of care/service billed.
• Other duties as assigned.
• May require communication with medical providers regarding clinical reductions on their bill.
• Working with client to review litigated bills.
• Provide clinical review on bills.
• Communicate in both written and oral responses regarding provider bills.

Requirements

• Licensed Registered Nurse
• Clinical experience in a hospital/ASC setting (i.e. surgery, orthopedics, trauma, and/or emergency room)
• Knowledgeable with computers and basic computer skills.
• Excellent oral and written communication skills.
• Ability to work with WORD and EXCEL documents.

Preferences

• Worker’s Compensation experience