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 dailyAnalyze 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 proceduresAchieve production goals to maintain turn-around-time per client contractsAchieve payment accuracy goalsGenerate accurate and easy-to-understand Explanation of Review (EOR) statements and correspondence lettersParticipate in ongoing training to be in compliance with process changes and to enhance job skills and knowledgeParticipate in team meetings to communicate and learn knowledge and information related to job function, company, and industryFollow HIPAA and ARRA laws and regulationsReports to : Operations Manager
Requirements
High School Diploma required; some College preferredState Certification, Certification in a related field (i.e., CPC) a plus4+ years of medical billing (or related) experiencePrevious worker’s compensation industry experience a plusPrior 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 schedulesAbility to communicate clearly and effectively, in both written and verbal contexts, to peers, clients and providersA desire to continue to learn and improve both self and the organizationMathematical aptitude (calculating PPO discounts, savings shifts, percentage fees, negotiations, etc.)Practical problem-solving skillsAbility to organize resources and establish prioritiesAbility to facilitate a cooperative work environmentMeticulous attention to detailPatience to perform routine functions dailyExcellent time management skillsPhysical / Mental Demands :
Remaining in a seated positionEntering text or data into a computerVisual AcuityTalkingHearingRepetitive arm, hand, finger motionWork is normally performed in a typical interior / office work environment.Benefits
Health insurance (4 different plans to choose from)DentalVisionPaid 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 InsuranceFlexible Spending Accounts (FSA)Employee Assistance Program (EAP)Rise Well Wellness ProgramProfessional Development Reimbursement Program (PDRP)You will be part of our new Elevate program designed to recognize and reward employees for their hard work