Complex Medical Bill Reviewer
Genex Service LLC
Complex Medical Bill Reviewer
US--Remote
Job ID: 26-19013
Type: Regular Full-Time
# of Openings: 1
Category: Customer Service & Support
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
Location: Remote – Must reside in Eastern or Central Time Zone
Schedule:
- Central: 8:00 AM – 4:30 PM CT
- Eastern: 9:00 AM – 5:30 PM ET
Position Summary
We are seeking a detail-oriented and analytically driven Complex Bill Review Nurse to join our team. This role is responsible for reviewing and evaluating complex medical bills, including those associated with multiple surgical procedures and diagnostic services such as EMGs, to ensure accurate reimbursement in accordance with State Fee Schedules, clinical documentation, and billing guidelines.
This position combines clinical expertise with technical and coding aptitude, requiring the ability to interpret medical records, validate billing codes, and communicate determinations effectively.
Key Responsibilities
- Review and analyze complex medical bills, including multi-procedure surgical cases and diagnostic services
- Evaluate documentation such as operative reports and medical charts to ensure billing accuracy
- Compare assigned CPT and ICD codes against clinical documentation to verify appropriate coding
- Apply state-specific fee schedules and reimbursement policies to determine accurate payment outcomes
- Conduct bill re-evaluations and provide clear, compliant rationale for approvals or denials
- Collaborate with bill review specialists, nurses, and internal stakeholders to resolve complex cases
- Maintain high levels of accuracy and consistency while meeting productivity expectations
- Document findings and decisions clearly within internal systems
Qualifications
Qualifications
- Active, unrestricted LPN, LVN, or RN license in the state of residence (compact license not required)
- 2–3 years of clinical nursing experience
- Strong computer proficiency, including the ability to navigate complex systems and data-heavy platforms
- Demonstrated ability to quickly learn and apply medical coding concepts (CPT and ICD)
- High attention to detail with strong analytical and problem-solving skills
- Excellent written and verbal communication skills
What Makes This Role Challenging
- Learning medical coding: This role requires nurses to develop proficiency in CPT and ICD coding, which is not typically part of standard clinical practice
- Technical complexity: The bill review platform is highly detailed and requires strong digital fluency, similar to working in complex spreadsheet environments
- Productivity expectations: Once fully ramped, reviewers are expected to process approximately 40 bills per day while maintaining strict accuracy standards
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Extended onboarding period:
- 6–8 weeks of structured training
- 6–8 weeks of quality control (QC) review
- Total ramp-up of 3–6 months before independent production
Benefits
We’re committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $53,500 - $70,000 annually and will be based on a number of additional factors including skills, experience, and education.
The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
Don’t meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you’re excited about this role but your past experience doesn’t align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles.
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Equal employment opportunity, including veterans and individuals with disabilities.
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