Nurse Auditor - Medical Bill Review

September 27

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Rising Medical Solutions

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Medical Cost Containment • Medical Bill Negotiation • Medicare Set Aside Workers Compensation • Utlization Review Services • Medicare Set Aside Administration

201 - 500

Description

• Have you ever looked a medical bill and immediately noticed something was wrong? • Join our team and maximize client savings by reviewing medical bills from a nurse perspective. • You'll be a part of our mission by giving clients the information they need to determine case value. • 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 charges are in accordance with the services ordered and authorized. • Adhere to quality standards, state billing guidelines, HIPAA rules, and confidentiality of all information. • Negotiate bills and conduct re-evaluation reviews as required. • Serve as a resource person to co-workers. • Maintain in-depth knowledge of all company products and services through ongoing training. • Perform other administrative or corporate duties upon request.

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.