Nurse Auditor - Medical Bill Review (Remote)

Rising Medical Solutions, LLC; Chicago (IL); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health insurance

401(k) with company match

Paid time off

Flexible hybrid schedule

Unlimited coffee

Job summary

Rising Medical Solutions, LLC is seeking a Nurse Auditor to review medical bills and ensure billing and coding accuracy. This role focuses on maximizing client savings through audits and evaluations of medical records.

The ideal candidate will have an active RN or LPN license, clinical experience in acute care, and a customer service orientation, along with certifications like CPC. The position offers a flexible hybrid schedule and competitive benefits including health insurance and 401(k) with company match.

Qualifications

• 3-5 years of clinical experience in acute care, surgery, and/or orthopedic.
• Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures.
• Workers’ Compensation medical bill review experience is a major plus.

Responsibilities

• Audit medical and billing records to determine if services provided are reasonable, appropriate and necessary.
• Clinically identify and evaluate charges not related to the occurrence.
• Negotiate bills and conduct re-evaluation reviews as required.

Skills

Clinical experience in acute care

Communication skills

Understanding of CPT and ICD-10 codes

Customer service orientation

Education

RN (or LPN) with active professional license

CPC and/or CPC-H certification

Job description

Have you ever looked a medical bill and immediately noticed something was wrong? Were you itching to use your expertise to fix it? We've been there, too. In fact, that's how our business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment.

Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and erroneous charges. We pride ourselves on outstanding customer service and work hard to keep our impeccable reputation in the industry.

In this role, you'll be a part of our mission by giving clients the information they need to determine case value based on evaluation of medical records and medical billing statements, and will:

Responsibilities

• 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.
• Negotiate bills and conduct re-evaluation reviews as required

All while maintaining a human touch, demonstrating sensitivity to culturally-diverse people and situations.

Qualifications

• 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
• Understanding of CPT and ICD-10 codes and Medicare guidelines
• Ability to apply knowledge to state fee schedules
• A customer service orientation, including strong communication skills
• Experience in any deposition or litigation cases a plus

Benefits

• Competitive benefits package, including health insurance, 401(k) with company match, paid time off, paid holidays, and more.
• Flexible hybrid schedule with in-office days reserved for training and collaborative meetings
• Employment within a firm committed to core values, staff development, emerging technology, private ownership, and controlled growth/reinvestment in the future - we frequently promote from within!
• Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers.
• A relaxed, yet upbeat work environment
• And for those in the office: casual dress code with unlimited coffee!