Senior Complex Bill Reviewer jobs in United States
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Enlyte ยท 7 hours ago

Senior Complex Bill Reviewer

positionUnited States
timeFull-time
remoteRemote
seniorityMid, Senior Level
money$67K/yr - $77K/yr
date5+ years exp

Enlyte is a company that combines innovative technology and clinical expertise to support individuals recovering from workplace injuries or auto accidents. They are seeking a Senior Complex Bill Reviewer to evaluate medical documentation and billing for auto accident claims, ensuring compliance and identifying billing errors to enhance their auto claims processes.

Information ServicesInformation TechnologySoftware

Responsibilities

Review and analyze medical bills, treatment records, and diagnostic reports related to auto accident injuries
Identify billing errors, coding discrepancies, and duplicate charges
Determine if treatments are causally related to the auto accident
Apply jurisdictional fee schedules and reimbursement guidelines across multiple states
Identify potential fraud in medical billing
Flag treatments that appear unrelated to documented accident injuries
Document billing errors and unrelated treatments in standardized formats
Provide feedback regarding potential rule targets and program criteria

Qualification

Active RNLPNLVN license5+ years auto insurance experienceFee schedulesICD-10CPTHCPCS codingMedical bill review softwareAnalytical thinkingMedical terminologyAttention to detailCommunication skillsDocumentation skills

Required

Active RN, LPN, or LVN license in good standing
5+ years of experience in medical bill review specifically within the auto insurance industry
Experience working across multiple jurisdictions and states
Demonstrated knowledge of multiple state fee schedules and reimbursement guidelines
Experience with ICD-10, CPT, and HCPCS coding systems
Strong understanding of injury causation and ability to identify treatment patterns inconsistent with diagnosed injuries
Exceptional attention to detail and analytical thinking abilities
Proficiency in medical terminology, anatomy, and medical bill review software platforms
Ability to manage high volume workload efficiently while maintaining quality

Preferred

CPC credential
Experience with bodily injury evaluation
Knowledge of Personal Injury Protection (PIP) and No-Fault insurance regulations
Background in trauma, orthopedic, or rehabilitation nursing
Experience providing feedback and direction on process improvements
Strong documentation and communication skills for collaborating with leadership and vendors
Experience writing operational guidelines or manuals

Benefits

Medical
Dental
Vision
Health Savings Accounts / Flexible Spending Accounts
Life and AD&D Insurance
401(k)
Tuition Reimbursement

Company

Enlyte

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Enlyte is an information service company that provides case management, clinical software, and auto-physical damage solutions.
dateFounded in 1946
location
San Diego, California, USA
people-size5001-10000 employees
web-link
https://www.enlyte.com/

Funding

Current Stage
Late Stage

Leadership Team

J
Jen Herbert
Vice President, Specialty Sales
linkedin

Recent News

Morningstar.com
PartsTrader Announces Agreement to Be Acquired by Enlyte, Accelerating Innovation Across the Collision Industry
2025-12-18
PR Newswire
Enlyte to Acquire PartsTrader, Complementing Mitchell's Auto Physical Damage Technology Solutions
2025-12-18
PR Newswire
Enlyte Celebrates Eight Winners of the 10th Annual Heart of Case Management Award
2025-10-14
Company data provided by crunchbase