Nurse Auditor - Medical Bill Review

🕒 June 1

🌽 Illinois – Remote

🌽 Illinois – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Rising Medical Solutions

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1999

⚕️ Healthcare Insurance

☁️ SaaS

📋 Compliance

Healthcare Insurance • SaaS • Compliance

Rising Medical Solutions is a company that provides comprehensive solutions for managing the costs and quality of medical care. Their services include medical bill review, care optimization, provider negotiations, and analytics and technology solutions aimed at reducing medical costs and improving care outcomes. The company also offers Medicare compliance solutions, utilization review, peer review, and a variety of management services tailored to enhance the efficiency and effectiveness of medical claims management. Rising Medical Solutions focuses on delivering optimal care at the right price, using advanced analytics and risk modeling to inform decisions and improve service delivery for clients.

📋 Description

• 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. • Negotiate bills and conduct re-evaluation reviews as required • All while maintaining a human touch, demonstrating sensitivity to culturally-diverse people and situations.

🎯 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

• Competitive benefits package, including health insurance, 401(k) with company match, paid time off, paid holidays, and more. • Flexible hybrid schedule with in-office days reserved for training and collaborative meetings • 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 • And for those in the office: casual dress code with unlimited coffee!