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 auto insurance claims experience; an active RN, LPN, or LVN license in good standing highly preferred. 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 injuriesIdentify billing errors, coding discrepancies, and duplicate chargesDetermine if treatments are causally related to the auto accidentApply jurisdictional fee schedules and reimbursement guidelines across multiple statesIdentify potential fraud in medical billingFlag treatments that appear unrelated to documented accident injuriesDocument billing errors and unrelated treatments in standardized formatsProvide feedback regarding potential rule targets and program criteria.

Qualifications

Required:

Active RN, LPN, or LVN license in good standing5+ years of experience in medical bill review specifically within the auto insurance industryExperience working across multiple jurisdictions and statesDemonstrated knowledge of multiple state fee schedules and reimbursement guidelinesExperience with ICD-10, CPT, and HCPCS coding systemsStrong understanding of injury causation and ability to identify treatment patterns inconsistent with diagnosed injuriesExceptional attention to detail and analytical thinking abilitiesProficiency in medical terminology, anatomy, and medical bill review software platformsAbility to manage high volume workload efficiently while maintaining quality

Preferred:

CPC credentialExperience with bodily injury evaluationKnowledge of Personal Injury Protection (PIP) and No-Fault insurance regulationsBackground in trauma, orthopedic, or rehabilitation nursingExperience providing feedback and direction on process improvementsStrong documentation and communication skills for collaborating with leadership and vendorsExperience writing operational guidelines or manuals

Salary:

PI280858077