What are the responsibilities and job description for the Bill Review Nurse position at Summit Consulting, LLC?
Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers’ comp, we strive to provide an atmosphere of constant growth and development for our employees.
Summit provides workers’ compensation programs and services to thousands of employers throughout the Southeast.
Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it’s underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise.
At Great American, we value and recognize the benefits derived when people with different backgrounds and experiences work together to achieve business results. Our goal is to create a workplace where all employees feel included, empowered, and enabled to perform at their best.
So, if you’re ready for an altogether different workplace experience, get to know the people who know workers’ comp. Apply today.
Essential Job Functions and Responsibilities
Reviews Facility and Professional bills as it compares with medical records, diagnosis & agreements for appropriateness or inconsistencies.
Negotiates Pre-Surgical Services.
Performs audits seeking potential leakage and/or system or procedural improvements.
Provides professional advice and expertise to Claims staff in developing and providing medical and cost control procedures.
Provides technical advice to lower-level associates and other functional areas.
Assists with special projects as needed
May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.
Performs other duties as assigned.
The person hired for this position may work out of the Lakeland, FL office which offers a hybrid work environment of 3 days in the office and 2 days' work from home or may work full-time remote depending on availability.
#LI-Hybrid
Job Requirements
Education: Bachelor’s degree in Healthcare Management, Nursing, or a related field. R.N. (Registered Nurse) required.
Scope of Job/Qualifications:
RN license required
Experience and working knowledge of health insurance; Workers Compensation a plus
CPC certification
Understanding of hospital coding & bills rules
Highly organized
Analytical with ability to solve complicated multi-faceted problems
Company:
SCI Summit Consulting, LLCBenefits:
Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs.
We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees.
Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.