We treat out clients' money, time, health, and information as if it were our own.
Medical Cost Containment • Medical Bill Negotiation • Medicare Set Aside Workers Compensation • Utlization Review Services • Medicare Set Aside Administration
201 - 500
July 26
We treat out clients' money, time, health, and information as if it were our own.
Medical Cost Containment • Medical Bill Negotiation • Medicare Set Aside Workers Compensation • Utlization Review Services • Medicare Set Aside Administration
201 - 500
• Manage and/or assign files to appropriate staff members and initiate appropriate verbal and/or written contacts with employers, clients, claimants, and medical providers. • Set up files in all appropriate systems; assign files, when applicable, to the nurse • Facilitate and schedule appointments as needed, and keep the Telephonic Nurse Case Manager (TCM), clients, claimants, providers, and employers informed verbally and/or in writing of any changes, delays, updates, or problems • Maintain appropriate electronic and paper files • Obtain authorization for medical release of information from the adjuster, as necessary, for records acquisition • Interface with a variety of inter-disciplinary providers (e.g., PT, diagnostic, psychology, etc.) • Identify, maintain, and update participating providers • Utilize Share Point tool for evaluating case risk, and input all activities (including verbal and written discussions) into the Ultimate database and customer/client system • Answer incoming calls, and direct the call appropriately • Process all documents using computer, copier, and scanner • Search and copy the appropriate internal criteria guidelines, when appropriate • Screen all re-open files (subsequent URs) to determine duplicate requests, vs. an appeal request that is beyond the allotted timeframe, vs. a reconsideration, vs. a new UR • Basic invoicing • Continually improve job skills and knowledge of all company products and services as well as customer issues and needs, through ongoing training and self-directed research. • Adhere to company policies, procedures, and reporting requirements.
• Experience in any of the following disciplines a plus – CNA, Medical Assistant, Physical Therapy Aide, Workers’ Compensation, Medical Unit Claims Administrator, IME Coordinator, Medical Office Manager • Experience with workers' compensation or disability (a plus!) • Strong computer and internet skills (will work with programs including MS Word, Outlook, and Excel) • Basic knowledge of/ability to read medical reports, or enthusiastic about learning medical terminology • The ability to research evidence-based guidelines • Proficient verbal/telephone and written communication skills • A high level of efficiency, ability to maintain rapid workflow • An aptitude for learning, organization skills and the ability to follow systems and procedures • A time-management mindset, along with planning, and prioritization skills • The ability to multi-task in a fast-paced environment • The ability to work independently as well as part of a team • The ability to express empathy with injured and/or disabled people • Deductive reasoning and think outside the box for creative solutions • Independent thinking & problem-solving experience • A bachelor’s degree, or an Associate's/Certification with professional experience • A customer service mindset
• Competitive base salary, profit sharing, 401k matching, generous time off, and career growth opportunities • A relaxed, yet upbeat, work environment, with a jeans professional dress code • Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Rising Medical Solutions, Inc Profile (topworkplaces.com) • We're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical • Want to see more? Check out our: • Facebook: https://www.facebook.com/RisingMedicalSolutions • LinkedIn: http://www.linkedin.com/company/rising-medical-solutions • Glassdoor: http://www.glassdoor.com/Overview/Working-at-Rising-Medical-Solutions-
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