Clinical Program Nurse I

Job Description
Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.
Responsibilities
Medical Bill Review
Processes inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task.
Performs bill review process by utilizing appropriate resources.
Clarifies billing discrepancies to analyze and recommend appropriate reimbursement.
Documents pertinent information in the system bill notes to support reimbursement determination.
Performs reconsideration of bills, as per request, to ensure original bill processing determination is appropriate.
Collaborates objectively with peer physicians to facilitate determination of reimbursement.
Demonstrates knowledge and understanding of Broadspire medical department policies and procedures and ability to communicate same with internal/ external customers as necessary.
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