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Nurse Auditor - Medical Bill Review (Remote)
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.<br><br>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.<br><br>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:<br><br><ul><li>Audit medical and billing records to determine if services provided are reasonable, appropriate and necessary</li><li>Clinically identify and evaluate any charges not related to the occurrence</li><li>Verify that charges are in accordance with the services ordered and authorized</li><li>Initiate appropriate contacts with clients and medical providers as appropriate and necessary</li><li>Negotiate bills and conduct re-evaluation reviews as required<br><br></li></ul>All while maintaining a human touch, demonstrating sensitivity to culturally-diverse people and situations.<br><br><strong>Requirements<br><br></strong><ul><li>RN (or LPN) with active professional license or equivalent within states of operation</li><li>CPC and/or CPC-H certification(s) strongly desired</li><li>Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures</li><li>3-5 years of clinical experience in acute care, surgery and/or orthopedic </li><li>Workers' Compensation medical bill review experience a major plus</li><li>Understanding of CPT and ICD-10 codes and Medicare guidelines</li><li>Ability to apply knowledge to state fee schedules</li><li>A customer service orientation, including strong communication skills</li><li>Experience in any deposition or litigation cases a plus<br><br></li></ul><strong>Benefits<br><br></strong><ul><li>Competitive benefits package, including health insurance, 401(k) with company match, paid time off, paid holidays, and more</li><li>Flexible hybrid schedule with in-office days reserved for training and collaborative meetings</li><li>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!</li><li>Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers</li><li>A relaxed, yet upbeat work environment</li><li>And for those in the office: casual dress code with unlimited coffee!</li></ul>
