Clinical Review Specialist
Advance your career at Liberty Mutual Insurance - A Fortune 100 Company!
As a Clinical Review Specialist you will monitor and/or review medical bills for cost containment and perform audits of hospital bills or other institutional bills. You will serve as liaison with the medical community, advise staff on ways to control costs, and negotiate rates for medical services and supplies. You will directly interact with the bill payment team on quality, production, and training issues and be responsible for compilation of a detailed summary and analysis of medical records and recommendations on the medical management of submitted cases.
This position is located in Suwanee, GA.
- Perform hospital bill review including desk and on-site hospital bill auditing; provides recommendations on appropriate payment of medical bills and posts files to explain adjustments.
- Negotiate fees with providers, hospitals, and extended care facilities and maintains current database for new medical trends and unscheduled procedures along with specific jurisdictional fee schedules.
- Review incoming medical bills and/or analyzes product and general liability.
- Maintain current database including log of monthly activity on all reviewed cases from assignment to completion.
- Analyze medical records related to the case files referred and makes recommendations as to the compensability of medical care provided.
- Provide assistance on medical arbitration.
- Prepare and submits dispute resolutions to appropriate state agencies.
- Degree from an accredited nursing school required, Bachelor of Science in Nursing preferred.
- Current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law.
- Good negotiation skills to effectively negotiate fees with providers, hospitals and extended care facilities.
- Experience in insurance and bill review preferred.
- Excellent verbal and written communication skills required.
We value your hard work, integrity and commitment to positive change. In return for your service, it's our privilege to offer you benefits and rewards that support your life and well-being. To learn more about our benefit offerings please visit: https://LMI.co/Benefits
At Liberty Mutual, we give motivated, accomplished professionals the opportunity to help us redefine what insurance means; to work for a global leader with a deep sense of humanity and a focus on improving and protecting everyday lives. We create an inspired, collaborative environment, where people can take ownership of their work; push breakthrough ideas; and feel confident that their contributions will be valued and their growth championed.
We're dedicated to doing the right thing for our employees, because we know that their fulfillment and success leads us to great places. Life. Happiness. Innovation. Impact. Advancement. Whatever their pursuit, talented people find their path at Liberty Mutual.
Job: Nursing & Medical
Primary Location: United States-Wisconsin-Wausau
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