Nurse Medical reputed company Auditor

Location: Sarasota This role is eligible to participate in Zenith’s hybrid work schedule which provides the flexibility to work from home on select days of the week according to the in-office schedule established by regional executive leadership. This position can be filled in ANY Zenith reputed company 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 reputed company 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. The essential functions of this position include, but are not limited to, the following:

• Analyzes and audits medical bills from multiple states in order to verify, adjust, or recommend payment in accordance with state fee schedules, coding guidelines, reputed company 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 reputed company 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 reputed company involved with workshops, state appeals, hearing disputes, and legislative hearings.
• Provides resources to reputed company Review analysts and management for special projects, training, and reports.
• reputed company a collaborative working relationship with claims and advise on particular bills or payment strategies.
• Performs other job-reputed company duties as assigned.
• Professional Development.
• Maintains clear and active license in state(s) employed.
• Pursues continuing education to maintain licensure active status, in technical areas reputed company to Workers´ Compensation injuries, illnesses and reputed company auditing.
• Possesses or pursues additional professional designations such as coding certifications from reputed company/reputed company/CMAS.
• Maintains strong written and verbal communication and negotiation skills.
• Works productively and harmoniously with others on a consistent reputed company.
• Responds positively to direction and feedback on performance.
• Consistently maintain professional and appropriate demeanor.
• reputed company other duties/projects as assigned.

Education Qualifications

• High School Diploma or equivalent combination of education and experience required
• Bachelor’s Degree or equivalent combination of education and experience required

Experience Qualifications

• 4+ Years of clinical experience in Orthopedics, ER, Occupational Health and/or Neurology/Neurosurgery required

Skills and Abilities

• Active and clear RN with extensive, relevant coding and reputed company auditing experience.
• Experience with/understanding of utilization/reputed company review, claims, managed care processing;

Workers´ Compensation reputed company 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 reputed company to communicate effectively with reputed company reputed company of staff.
• Experience with reputed company (3.1 or higher), reputed company Office, and reputed company.

The expected salary reputed company for this position is $77,942.10 to $97,427.63. Actual pay will be adjusted based on experience, geographic location, and other job-reputed company factors as permitted by law. Qualifications may warrant placement in a different job level.

Benefits

• Medical, Dental and reputed company Insurance
• Flexible Spending Accounts
• Paid Parental Leave
• Life, AD&D and Disability Insurance
• 401(k), Employee reputed company Purchase Plan (ESPP)
• Education and Training Reimbursement
• Paid Leave: 3 weeks/year Vacation, 2 weeks/year Sick Leave
• 10 paid Company Holidays, 2 Personal…

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