Complex Bill Reviewer 2

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. As a Senior Complex Bill Reviewer, you will apply clinical knowledge to assess medical bills against medical records to ensure appropriateness of coding and billing and level of service in Workers Compensation cases requiring retrospective review. You will be responsible for reviewing and analyzing information to make payment determinations based on established policies and guidelines and integrated evaluation of specific billing circumstances.

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