REMOTE Clinical Bill Review Nurse - 247103

Medix provides workforce solutions to clients and creates opportunity for talent in the Healthcare, Life Sciences, Engineering and Technology fields. Through our core purpose of positively impacting lives, we have earned our reputation as an industry leader by providing unsurpassed customer service and top quality professionals to our clients.

Clinical Bill Review Nurse (Remote) Multiple States Eligible: AL, AZ, CA, CO, DE, FL, GA, IA, IL, KY, MA, MD, MI, MS, NC, NJ, NM, NY, NV, OH, OR, PA, SC, TN, TX, UT, VA, WA Overview: We are seeking an experienced Clinical Bill Review Nurse to join our team and support accurate, compliant, and clinically appropriate reimbursement within the workers’ compensation space. In this role, you will review medical bills and supporting documentation to ensure correct coding, medical necessity, adherence to treatment guidelines, and compliance with jurisdiction-specific regulations. This position plays a key role in payment integrity by identifying inappropriate charges and providing clinical expertise to guide fair payment decisions.

Conduct detailed clinical reviews of medical bills to assess medical necessity, appropriateness of care, and alignment with workers’ compensation treatment guidelines. Identify billing discrepancies—including unbundling, upcoding, duplicate billing, and non-compensable services. Apply jurisdiction-specific fee schedules, UR protocols, and treatment guidelines (including ODG and MTUS). Collaborate closely with bill review analysts, adjusters, and providers to clarify clinical details and resolve billing issues. Document clinical rationale for payment recommendations, reductions, or denials in accordance with regulatory and client requirements. Maintain up-to-date knowledge of workers’ compensation regulations, medical coding (ICD, CPT, HCPCS), and evidence-based clinical best practices. Support quality assurance initiatives and contribute to ongoing process improvement within the bill review workflow.