Job Description

Job Description

Job Description

Have you ever looked a medical bill and immediately noticed something was wrong? Were you itching to use your expertise to fix it? We've been there, too. In fact, that's how our business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment.

Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and erroneous charges. We pride ourselves on outstanding customer service and work hard to keep our impeccable reputation in the industry.

In this role, you'll be a part of our mission by giving clients the information they need to determine case value based on evaluation of medical records and medical billing statements, and will:

• Audit medical and billing records to determine if services provided are reasonable, appropriate and necessary.
• Clinically identify and evaluate any charges not related to the occurrence.
• Verify that charges are in accordance with the services ordered and authorized.
• Initiate appropriate contacts with clients and medical providers as appropriate and necessary.
• Consistently meet productivity and turn-around time requirements.
• Adhere to quality standards, state billing guidelines, HIPAA rules, and confidentiality of all information, policies, and procedures.
• Negotiate bills and conduct re-evaluation reviews as required
• Conduct re-evaluation reviews as required.
• Serve as a resource person to co-workers.
• Demonstrate sensitivity to culturally diverse people and situations.
• Continually improve job skills and maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research.
• Follow appropriate report formats and documentation guidelines.
• Perform other administrative or corporate duties upon request.

All while maintaining a human touch, demonstrating sensitivity to culturally-diverse people and situations.

This position is part time 20-24 hours a week.

Requirements

• RN (or LPN) with active professional license or equivalent within states of operation
• CPC and/or CPC-H certification(s) strongly desired
• Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures
• 3-5 years of clinical experience in acute care, surgery and/or orthopedic
• Workers’ Compensation medical bill review experience a major plus
• Understanding of CPT and ICD-10 codes and Medicare guidelines
• Ability to apply knowledge to state fee schedules
• A customer service orientation, including strong communication skills
• Experience in any deposition or litigation cases a plus

Benefits

• Remote position
• Employment within a firm committed to core values, staff development, emerging technology, private ownership, and controlled growth/reinvestment in the future - we frequently promote from within!
• Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers.
• A relaxed, yet upbeat work environment.
• You will be part of our new Elevate program designed to recognize and reward employees for their hard work.

About Us:

Headquartered in Chicago, RISING Medical Solutions is a privately held, financial solutions organization offering medical cost containment and care management services. With offices, providers, and case managers nationwide, RISING provides comprehensive medical claims solutions to our valued clients: insurance carriers, Fortune 1000 employers, third party administrators, and government organizations. At RISING, we’re committed to:

• Continuous technological improvement
• Entrepreneurial attitude
• Seven core values that emphasize teamwork, ethical behavior, customer service, continual improvement, positive attitude, focusing on what's really important, and keeping a sense of humor
• Responding quickly to client needs
• Being the best, not the biggest

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