Dynamic and results-oriented Complex Bill Review Nurse at Zurich NA, skilled in validating treatment accuracy and identifying fraudulent billing. A collaborative team player with strong attention to detail, I enhance service efficiency through process improvements and critical thinking, ensuring compliance with regulations while delivering high-quality outcomes.
Validate appropriate treatment and billing charges against compensable injury.
Review ICD 10 codes and CPT codes against the medical documentation submitted for accuracy.
Assist in identification of fraudulent billing by reporting suspicious activity to the special investigation unit.
Ensure legal compliance by following regional, country and or local laws and regulations and internal control requirements.
Meet quality standards and complete monthly peer review audits.
Improve accuracy and timeliness of services by identifying problems, providing solutions and implementing procedural and process improvements.
Resolve escalated issues using critical thinking skills, applying medical expertise, and referring to policies, procedures and specifications.
Prepare patients for examinations and document medical histories.
Assist physician during the examination and procedures.
Triage phone calls and provide clinical information and guidance.
Collect laboratory specimens, perform point of care lab testing, phlebotomy services, suture removal and obtain electrocardiograms.
Obtain patient vital signs and document patient information in EMR.
Assist physicians with in-office procedures.
Perform phlebotomy services.
Clean and sanitize all equipment.
Scan medical records, schedule appointments, enter daily charges, and perform any additional clinical and clerical office procedures as needed.
Collaborative team player
Self-motivated
Attention to detail
Adaptability and organization
Results-oriented
Computer skills- Microsoft Word, Excel, Claims Connect, EZAccess, Smart Advisor, and Teams