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

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