Description
Mitchell International
Senior Complex Bill Reviewer
US--Remote
Job ID: 25-18436
Type: Regular Full-Time
# of Openings: 1
Category: Insurance & Administration
Mitchell International, Inc.
Overview
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.
Responsibilities
This is a full-time, remote position. Candidates may reside anywhere within the U.S.
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 and help shape our expanding auto claims division. We're seeking an experienced RN, LPN, or LVN with specialized expertise in auto insurance claims to serve as a subject matter expert in this growing area. In this influential role, you'll evaluate medical documentation and billing for auto accident claims, identify billing errors and unrelated treatments, ensure compliance with multi-jurisdictional guidelines, and provide critical input that will define our auto claims processes moving forward. This is a unique opportunity to leverage your expertise while making a significant impact on our program's development.
Key Responsibilities
- Review and analyze medical bills, treatment records, and diagnostic reports related to auto accident injuries
- Identify billing errors, coding discrepancies, and duplicate charges
- Determine if treatments are causally related to the auto accident
- Apply jurisdictional fee schedules and reimbursement guidelines across multiple states
- Identify potential fraud in medical billing
- Flag treatments that appear unrelated to documented accident injuries
- Document billing errors and unrelated treatments in standardized formats
- Provide feedback regarding potential rule targets and program criteria.
Qualifications
Required:
- Active RN, LPN, or LVN license in good standing
- 5+ years of experience in medical bill review specifically within the auto insurance industry
- Experience working across multiple jurisdictions and states
- Demonstrated knowledge of multiple state fee schedules and reimbursement guidelines
- Experience with ICD-10, CPT, and HCPCS coding systems
- Strong understanding of injury causation and ability to identify treatment patterns inconsistent with diagnosed injuries
- Exceptional attention to detail and analytical thinking abilities
- Proficiency in medical terminology, anatomy, and medical bill review software platforms
- Ability to manage high volume workload efficiently while maintaining quality
Preferred:
- CPC credential
- Experience with bodily injury evaluation
- Knowledge of Personal Injury Protection (PIP) and No-Fault insurance regulations
- Background in trauma, orthopedic, or rehabilitation nursing
- Experience providing feedback and direction on process improvements
- Strong documentation and communication skills for collaborating with leadership and vendors
- Experience writing operational guidelines or manuals
Salary:
PI278994432
