Rising Medical Solutions

Data Entry

• You will have the opportunity to obtain maximum savings for clients by accurately entering data and reviewing medical bills according to state laws, fee schedules, and other guidelines.
• Most of your day will include seated computer work performing data entry on workers' compensation-related medical bills.
• This position does have production and accuracy performance metrics, so if you are someone who thrives and is motivated by structured individual performance goals, this position may be a good fit.

Data Entry Associate – Entry-Level Healthcare Office Role

Customer Support

• Communicate with medical providers primarily via telephone and email to obtain needed information and resolve bill-specific issues
• Provide world-class customer service by responding to and answering questions quickly and professionally
• Demonstrate an intimate knowledge of clients’ needs, empathy for customers’ situations, and knowledge of appropriate language
• Serve as a role model to internal, client, partner, and vendor representatives by following guidelines to ensure stellar service is provided with each call

Customer Service Representative

Auditor

• Headquartered in Chicago, RISING Medical Solutions provides medical cost containment and care management services to insurers, employers, TPAs, and government organizations
• Maximize savings for clients by analyzing and processing medical bills according to state laws and fee schedules, industry standards, network contracts, client instructions, and company policies
• Analyze small to mid-size dollar threshold medical bills for payment recommendations considering worker’s compensation law, fee schedules, usual and customary rates (UCR), current PPO contracts, coding and bundling guidelines, client instructions and claim history
• 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 comply with process changes and enhance skills and knowledge
• Participate in team meetings to communicate and learn job-, company-, and industry-related information
• Follow HIPAA and ARRA laws and regulations
• Reports to Operations Manager

Senior Medical Bill Review Auditor

Insurance

• Maintain ongoing knowledge of program requirements
• Analyze and process claims for accuracy, eligibility, and benefits coverage
• Retain and strengthen relationships with clients and members
• Assist members in managing and resolving reimbursement issues related to medical services and covered expenses that are medically necessary
• Correspond to verify if the amounts are related to the claim
• Develop and maintain a working knowledge of medical bill processing, procedures, and supporting systems
• Adhere to quality assurance objectives and goals
• Develop and maintain a working knowledge of all support systems to ensure ever increasing client value and Rising’s returns from administration services
• Research and utilize problem-solving skills to resolve claim discrepancies, errors, or incomplete information by communicating with providers, members, or internal departments
• Keep management updated on activities, issues and developments
• Document all claims decisions and communications with members in the system accurately and timely
• Ensure strict confidentiality of all medical information and adhere to privacy regulations and company policies
• Perform special projects as assigned by management
• Reports to: Program Manager

Medical Claims Specialist

Project Manager

• Provide planning and leadership on projects and client integrations to both internal and external customers
• Translate business requirements into technical requirements and solutions
• Represent Rising in client meetings regarding new business initiatives and/or changes
• Utilize statistical concepts and quantitative methods to develop baseline measures, identify root cause and reduce and/or eliminate internal/external failures
• Proactively identify improvement opportunities
• Provide guidance to both the client and internal project members for the utilization of best practices and workflows efficient for both parties
• Demonstrate ability to quantify results in terms of cost savings and impact on key performance indicators
• Formulate use cases, process flows and training material on projects and client integrations
• Support the creation of and/or create test plans and training materials relevant to the project
• Collaborate with resources to ensure all system design requirements adequately reflect the defined business processes and fully support all components of the functional business requirements
• Will oversee the Implementation Team, while working directly with senior leadership and other department heads

Data Entry Associate – Entry-Level Healthcare Office Role

Customer Service Representative

Senior Medical Bill Review Auditor

Medical Claims Specialist

Implementation/Project Manager