Conduent Bill Review Nurse in Lakeland, Florida

Bill Review Nurse


Conduent is the world's largest provider of diversified business process services with leading capabilities in transaction processing, automation, analytics and constituent experience. We work with both government and commercial customers in assisting them to deliver quality services to the people they serve.

We manage interactions with patients and the insured for a significant portion of the U.S. healthcare industry. We are the customer interface for large segments of the technology industry and the operational and processing partner of choice for public transportation systems around the world.

Whether it's digital payments, claims processing, benefit administration, automated tolling, customer care or distributed learning - Conduent manages and modernizes these interactions to create value for both our clients and their constituents. Learn more at .

Job Summary:

The Medically Managed Bill Review Nurse is responsible for retrospective utilization management activities per specified state bill review guidelines and Bunch bill review protocols. He/she is responsible for the audit of complex medical bills to review utilization of services, as well as medical necessity, and to assess the appropriateness of charges.

Minimum Qualifications:

  1. LPN/LVN with two years clinical nursing experience.

  2. Knowledgeable in computer operations, including Windows operating system, data entry skills and 10-key capabilities.

  3. Knowledge of ICD-9 and CPT coding procedures.

  4. Previous nursing roles dealing with specialties: in Occupational Health, Orthopedics, Hospital, Surgery Center, ER.

  5. Must demonstrate the ability to understand state laws and utilization guidelines as they apply to bill review activity.

  6. Active and unencumbered professional license.

Essential Duties:

  1. Demonstrates basic problem solving skills to ensure early intervention and identification of those injuries which will benefit from medical case management or to identify questionable claims during the retrospective bill review process.

  2. Demonstrates basic knowledge of UR process.

  3. Demonstrates basic knowledge of ICD-9 coding.

  4. Demonstrates basic knowledge of HCFA billing and CPT and HCPCS coding.

  5. Demonstrates basic knowledge of UB billing, Primary Procedure codes, revenue codes and jurisdictional direction regarding use.

  6. Demonstrates basic knowledge of CCI edits.

  7. Review of complex HCFA bills to determine authorization, relation to injury and appropriateness of service.

  8. Review of complex UB bills to determine authorization, relation to injury and appropriateness of service

  9. May refer high dollar bills to BR department for advanced negotiation as identified in negotiation protocol.

If this describes you, the timing is right, AND you HAVE the required skills & experience, please apply/send resume to DeVonda Manning at .

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the "Submit" button at the bottom of the form. For those using Google Chrome or Mozilla Firefox please download the form first: click here to access or download the form at .

Job Service Delivery Healthcare

Primary Location United States-Florida-Lakeland

Organization Financial Service Healthcare

Unposting Date Jan 5, 2019, 11:59:00 PM

Req ID: 18024708