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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