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Bill Review Nurse
Great American Insurance Group. Review facility and professional bills against medical records, diagnoses, and agreements for appropriateness or inconsistencies .
Posted 9/30/2026full-timeLakeland • Florida • United StatesSeniorLead💰 $76,950 - $108,870 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expert knowledge of managed care laws and regulations, with advanced analytical skills for data analysis and problem-solving. Proficient in case management, including organizing and prioritizing caseloads while ensuring compliance with industry standards.
Highest-signal resume keywords
Bachelor's Degree In Healthcare ManagementRegistered Nurse (R.N.)14 Years Of Case Management ExperienceExpert Knowledge Of Managed Care LawsAdvanced Analytical Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ManagementManaged Care ExperienceData AnalysisProblem IdentificationSolution Development
Soft Skills
Interpersonal SkillsCommunication SkillsCoachingTalent Development
Certifications & Qualifications
Registered Nurse (R.N.)
Industry Keywords
Healthcare ManagementConfidential Information HandlingEmerging LegislationIndustry StandardsCost-Control Procedures
About the role
Key responsibilities & impact- Review facility and professional bills against medical records, diagnoses, and agreements for appropriateness or inconsistencies
- Negotiate pre-surgical services
- Perform audits to identify potential leakage and system or procedural improvements
- Advise Claims staff on medical and cost-control procedures
- Provide technical advice to lower-level associates and other functional areas
- Assist with special projects
- Potentially oversee and coach staff and participate in talent selection, development, and performance management decisions
- Perform other assigned duties
Requirements
What you’ll need- Bachelor’s degree in Healthcare Management, Nursing, or a related field
- R.N. (Registered Nurse) required
- Minimum of 14 years of case management or managed care experience
- Expert knowledge of managed care laws and regulations
- Advanced ability to identify and address nuanced details impacting case management
- Expert proficiency organizing and prioritizing caseloads and ensuring timely completion
- Excellent interpersonal and communication skills
- Knowledge of emerging legislation and industry standards
- Ability to handle confidential information with discretion
- Advanced analytical skills for analyzing data, identifying problems, and developing solutions
- Recognized subject matter expertise
- Must be authorized to work in the United States without current or future sponsorship
Benefits
Comp & perks- Medical coverage
- Dental coverage
- Vision coverage
- Wellness plans
- Parental leave
- Adoption assistance
- Tuition reimbursement
- Paid Time Off
- Paid holidays
- 401(k) plan with company match
- Employee stock purchase plan
- Commuter benefits
- Flexible work arrangement, with one day remotely for the standard hybrid schedule