Description

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.

This is a full-time, remote position. Candidate will work Eastern/Central Time Zone schedule.

Must have an active RN, LPN, or LVN license in good standing.

Join our Casualty Solutions Group (CSG) technology team as a Senior Complex Bill Reviewer 2. In this remote position, you'll apply your clinical expertise to our cutting-edge bill review platform, ensuring accurate and cost-effective claim processing for workers' compensation cases. In this role, you will:

• Conduct medical reviews of individual provider, hospital bills, specialty claims and adjustments for coding and billing accuracy and to ensure compliance with company policies and procedures and state guidelines
• Review documentation to identify unsupported or incorrectly billed codes
• Audit of complex medicals bills and a variety of insurance claims: workers compensation, auto, liability
• Use independent judgment and clinical knowledge to adjust bill payment as appropriate to comply with company policies
• Identify and recommend opportunities for bill reductions to enhance client cost management outcomes
• Process and/or review claims for compliance in a timely manner that meets or exceeds production and quality goals
• May serve as subject matter expert or training resource for team, identify training opportunities and assist with complex questions regarding review process, code review, and determination of appropriate courses of action to resolve escalated issues

• Registered Nurse (RN), License Practical Nurse (LPN), Licensed Vocational Nurse (LVN) with active state license in good standing in the state where job duties are performed. Required
• Registered Nurse Certified Professional Coder Plus
• 3-5 years clinical experience, particularly in Operating Room/Implants, Emergency Room, and specialized areas
• Proficiency in medical coding (CPT, HCPCS, ICD-10) and billing guidelines
• Previous experience in medical claim review, workers compensation, case management, utilization review, auto liability, and orthopedics preferred.
• Experience with electronic medical records and bill review platforms (Smart Advisor Plus preferred)
• Performance Metrics related to bills per hour and quality scores (Payment, Procedural, Financial Accuracy)
• Excellent verbal and written communication abilities
• Strong analytical, problem-solving, and decision-making skills
• Demonstrated ability to work independently on project assignments.
• Proficiency in Microsoft Office suite and adaptability to proprietary software

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