Rising Medical Solutions

Senior Medical Bill Review Auditor

Rising Medical Solutions

full-time

Posted on:

Location Type: Hybrid

Location: Milwaukee • Wisconsin • 🇺🇸 United States

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Job Level

Senior

About the role

  • 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

Requirements

  • High School Diploma required; some College preferred
  • State Certification or related certification (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 (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
  • Desire to continue to learn and improve
  • 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 seated; entering text or data into a computer; visual acuity; talking; hearing; repetitive arm/hand/finger motion; 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)
  • Elevate employee recognition and rewards program

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
medical billingdata entryfee schedulescoding guidelinesbundling guidelinespayment recommendationsmathematical aptitudeproduction goalspayment accuracyHIPAA compliance
Soft skills
communication skillsproblem-solving skillsorganizational skillsattention to detailtime managementcooperative work environmentdesire to learnpatienceanalytical skillsability to prioritize
Certifications
High School DiplomaState CertificationCPC