Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
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RN Bill Review
PRIMARY PURPOSE : To review hospital and professional medical bills from providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Applies clinical editing.
Reviews operative reports to determine if surgery services were appropriately billed.
Reviews complex medical, legal and consult services.
Contacts client or facility to obtain additional or missing information.
Handles provider appeals as appropriate to fee schedule and contractual disputes.
Identifies and effects reductions on selected medical bills that are determined to include inappropriate, unrelated or undocumented charges within state specific workers' compensation laws rules and regulations.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travel as required.
Education & Licensing
Bachelor's degree from an accredited college or university preferred. RN license required.
Experience
Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years workers' compensation/bill review experience in multi-state jurisdiction; prior experience in PPO provider appeals, re-pricing, surgery review, by report and RNE review; two (2) years of experience with complex medical, legal and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review.
Skills & Knowledge
Extensive knowledge of re-pricing rules and guidelines
Knowledge of medical terminology, anatomy and surgical terminology
Knowledge of CPT/ICD9
PC literate, including Microsoft Office products
High level of accuracy and attention to detail
Ability to multi task and function in high volume area
Problem solving skills and ability to handle deadlines
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $70,000-$72.000 . A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Always accepting applications.
#RN #billreview
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
Taking care of people is at the heart of everything we do. Caring counts
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)
