Nurse Auditor – Remote in Chicago, IL

Nurse Auditor - Remote - Rising Medical Solutions - Chicago, IL - work from home job Company: Rising Medical Solutions Job description: The Nurse Auditor will maximize client’s savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization and erroneous charges. This position will provide outstanding customer service to clients by giving them the information they need to determine case value based on evaluation of medical records and medical billing statements. Core Responsibilities include: • Audit medical and billing records to determine if services provided are reasonable, appropriate and necessary. • Clinically identify and evaluate any charges not related to the occurrence. • Verify that charges are in accordance with the services ordered and authorized. • Initiate appropriate contacts with clients and medical providers as appropriate and necessary. • Consistently meet productivity and turn-around time requirements. • Adhere to quality standards, state billing guidelines, HIPAA rules, and confidentiality of all information, policies, and procedures. • Negotiate bills as required. • Conduct re-evaluation reviews as required. • Serve as a resource person to co-workers. • Demonstrate sensitivity to culturally diverse people and situations. • Advise supervisor of any potential problems as they become evident. • Continually improve job skills and maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research. • Adhere to company policies, procedures, and reporting requirements. • Follow appropriate report formats and documentation guidelines. • Perform other administrative or corporate duties upon request. Reports to: • Nurse Auditor Supervisor • Regularly interacts internally with other members of the Specialty Services department, including LMBA, Provider Relations, Specialty Bill Review (SBR) and other Rising staff. Regularly interacts externally with clients, providers (e.g. physicians, chiropractors, office managers, billers, etc.). Requirements • Minimum of 2-years of college or Associates Degree • RN (or LPN) with active professional license or equivalent within states of operation • CPC and/or CPC-H certification(s) strongly desired • Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures • 3-5 years of clinical experience in acute care, surgery and/or orthopedic. • Workers’ Compensation medical bill review experience a major plus. • Well-developed time-management, organization, and prioritization skills. • Excellent analytical skills and ability to spot “red flags” on medical bills and records. • Negotiation skills are a plus. • Excellent written and oral communication skills. • Strong interpersonal and conflict resolution skills. • Experience in a fast-paced, multi-faceted environment. • Demonstrated patience, persistence and attention to detail. • Strong achievement motivation and an ability to stay focused on task accomplishment. • Understanding of CPT and ICD-10 codes and Medicare guidelines. • Mastery of bill audit application, MS Access, Word, Excel, and Outlook • Customer-service oriented Working Conditions: • Remaining in a seated position • Entering text or data into a computer • Visual Acuity • Talking • Hearing • Repetitive arm, hand, finger motion • Working remotely some or all the time • Traveling to office when neeeded 10% Benefits • Health insurance (4 different plans to choose from) • Dental • Vision • Paid time off (PTO) • 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 About Us: 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 Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Expected salary: Location: Chicago, IL Job date: Fri, 28 Jul 2023 22:24:21 GMT Apply for the job now! Apply tot his job