Clinical Program Nurse Specialist
6 days ago
Crawford Group seeks a highly skilled Clinical Program Nurse to join our team. As a key member of our medical billing team, you will play a critical role in promoting excellence in medical bill review and process improvement.
About the Role- This position involves auditing in-patient and/or surgical bills, ensuring adherence to standard operating procedures (SOP) and turnaround times.
- You will perform bill review processes using appropriate resources, clarify billing discrepancies, and recommend reimbursement accordingly.
- Excellent communication and analytical skills are required to collaborate with peer physicians and provide support to Business Process Associates.
- Medical Bill Review
- Process inpatient and/or surgical bills by adhering to SOP and turnaround times.
- Perform bill review processes using appropriate resources.
- Clarify billing discrepancies to analyze and recommend reimbursement.
- Document pertinent information in the system bill notes to support reimbursement determination.
- Reconsider bills as per request, to ensure original bill processing determination is appropriate.
- Collaborate objectively with peer physicians to facilitate determination of reimbursement.
- Demonstrate knowledge and understanding of Crawford Group medical department policies and procedures.
- Business Process Support
- Provide assistance to Business Process Associates and other departments regarding billing issues and fee schedules.
- Inform process owners about calculation of reimbursement-related issues.
- Communicate effectively with case management personnel as needed.
- Liaise with company attorneys to assist in possible litigated claims.
- Refer matters beyond authority and expertise to immediate superior for direction.
- Uphold the Crawford Code of Conduct by protecting confidentiality of information.
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