Senior Medical Bill Review Auditor

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 daily
• Analyze 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 procedures
• 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 be in compliance with process changes and to enhance job skills and knowledge
• Participate in team meetings to communicate and learn knowledge and information related to job function, company, and industry
• Follow HIPAA and ARRA laws and regulations

Reports to:

Operations Manager

• High School Diploma required; some College preferred
• State Certification, Certification in a related field (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 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 schedules
• Ability to communicate clearly and effectively, in both written and verbal contexts, to peers, clients and providers
• A desire to continue to learn and improve both self and the organization
• 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 in a seated position
• Entering text or data into a computer
• Visual Acuity
• Talking
• Hearing
• Repetitive arm, hand, finger motion
• Work is normally performed in a typical interior/office work environment.

• 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)
• You will be part of our new Elevate program designed to recognize and reward employees for their hard work