Senior Medical Bill Review Auditor

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 important, and keeping a sense of humor
Responding quickly to client needs
Being the best, not the biggest
The Role:
The Senior Medical Bill Auditor will maximize savings for clients by accurately analyzing and processing medical bills according to state laws and fee schedules, industry standards, appropriate network contracts, client specific instructions, and company policies and procedures.
 
Core Responsibilities include:
Adhere to all company Core Values daily
Analyze small to mid-size dollar threshold medical bills for payment recommendations based on state worker’s compensation law, fee schedules, usual and customary rates (UCR), current PPO contracts, coding and bundling guidelines, client instructions, claim history, and company policies and procedures
Achieve production goals to maintain turn-around-time per client contracts
Achieve payment accuracy goals
Generate accurate and easy-to-understand Explanation of Review (EOR) statements and correspondence letters
Participate in ongoing training to be in compliance with process changes and to enhance job skills and knowledge
Participate in team meetings to communicate and learn knowledge and information related to job function, company, and industry
Follow HIPAA and ARRA laws and regulations
Reports to:
Operations Manager
Requirements
High School Diploma required; some College preferred
State Certification, Certification in a related field (i.e., CPC) a plus
4+ years of medical billing (or related) experience
Previous worker’s compensation industry experience a plus
Prior experience with Microsoft Windows and Office applications (Word, Excel, Outlook, etc.)
Strong data entry speed and accuracy required (Minimum of 10,000 keystrokes per hour, data entry accuracy of at least 93%)
Ability to read, analyze and interpret technical procedures, state laws, coding/bundling guidelines and fee schedules
Ability to communicate clearly and effectively, in both written and verbal contexts, to peers, clients and providers
A desire to continue to learn and improve both self and the organization
Mathematical aptitude (calculating PPO discounts, savings shifts, percentage fees, negotiations, etc.)
Practical problem-solving skills
Ability to organize resources and establish priorities
Ability to facilitate a cooperative work environment
Meticulous attention to detail
Patience to perform routine functions daily
Excellent time management skills
Physical/Mental Demands:
Remaining in a seated position
Entering text or data into a computer
Visual Acuity
Talking
Hearing
Repetitive arm, hand, finger motion
Work is normally performed in a typical interior/office work environment.
Benefits
Health insurance (4 different plans to choose from)
Dental
Vision
Paid time off (PTO) or Flexible Time Off (FTO)
401(k)
Basic Life Insurance and Long-Term Disability Insurance (paid by the company)
Voluntary Life Insurance and Short-Term Disability Insurance
Flexible Spending Accounts (FSA)
Employee Assistance Program (EAP)
Rise Well Wellness Program
Professional Development Reimbursement Program (PDRP)
You will be part of our new Elevate program designed to recognize and reward employees for their hard work