Clinical Program Nurse I

Job Overview

Clinical Program Nurse I role at Crawford & Company. Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.

Responsibilities

• Medical Bill Review – Process inpatient and/or surgical bills by adhering to SOP and turnaround time.
• Perform bill review process utilizing appropriate resources.
• Clarify billing discrepancies to analyze and recommend appropriate reimbursement.
• Document pertinent information in system bill notes to support reimbursement determination.
• Perform reconsideration of 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 Broadspire medical department policies and procedures and communicate same with internal/external custome...