Strategic Bill Review Analyst - Workers' Compensation

Rising Medical Solutions; Milwaukee (WI); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Competitive base salary

401(k) matching

Generous time off

Career growth opportunities

Relaxed work environment

Job summary

Rising Medical Solutions is looking for a Strategic Bill Review Analyst in Milwaukee, Wisconsin. This role requires expertise in analyzing large medical bills, ensuring compliance with coding and state laws, and providing excellent customer service.

The ideal candidate will possess a minimum of one year of medical bill auditing experience and excellent communication skills. Benefits include a competitive salary, profit sharing, and career growth opportunities.

Qualifications

• Minimum one to three years of experience in medical bill review or auditing.
• CPC certification is required within two years of hiring.
• Ability to analyze technical procedures, state laws, and fee schedules.

Responsibilities

• Review and organize litigation responses for bill review accuracy.
• Analyze specialty bill review bills and make payment recommendations.
• Communicate with clients and medical providers regarding bill issues.

Skills

Medical bill review/auditing

CPT codes interpretation

Customer service

Use of software tools (Vision, Smart Advisor)

Education

High School Diploma

Associate or Bachelor Degree

CPC certification

Job description

The Strategic Bill Review Analyst will maximize savings for clients by accurately analyzing and processing large medical bills according to appropriate coding review, medical necessity determination, state laws and fee schedules, appropriate network contracts, client specific instructions, and company policies and procedures. This person also uses their expertise to identify ancillary product trends and deliver AR/AP reporting.

Core Responsibilities

• Review and organize litigation responses. Work with various Operations teams to ensure bill review accuracy, defend Rising repricing strategies and updating processes as needed.
• Appear as an expert witness on an as‑needed basis for litigated cases, hearings, depositions and fee coder affidavits.
• Drive innovation with bill review repricing strategies ensuring workflow creation and proper documentation.
• Drive specialty bill review repricing strategies and product development including but not limited to Rising Fair and Reasonable network reductions, Second Look, Rising Guarantee program, etc.
• Accurately and appropriately analyze specialty bill review bills, large medical bills and make payment recommendations based on claim history, medical notes, usual and customary rates (UCR), state laws and fee schedules, available PPO contracts, coding guidelines, client instructions, and company policies and procedures.
• Maximize productivity through proficient use of various software programs and reference tools, including Vision, Smart Advisor, Excel, Internet, and company‑developed applications.
• Communicate with medical providers to obtain needed information and resolve bill‑specific issues.
• Communicate directly with clients, offering world‑class customer service by responding to and answering their questions quickly and professionally.
• Participate in ongoing training to enhance job skills and knowledge.
• Mentor and train less‑experienced Auditors.
• Special projects as assigned by management.

Requirements

• High School Diploma required; Associate or Bachelor Degree preferred.
• CPC (Certified Professional Coding) coursework or certification a big plus.
• CPC certification required within two years of assuming the position.
• Minimum one to three years of medical bill review/auditing and/or medical bill negotiation, or equivalent combination of education and experience.
• Other medical/health care/insurance industry experience a plus.
• Ability to read, analyze, and interpret technical procedures, medical reports, state laws and fee schedules, and CPT codes.
• Ability to effectively present information and respond to questions from peers, clients, and providers.

Benefits

• Competitive base salary, profit sharing, 401(k) matching, generous time off, and career growth opportunities.
• A relaxed, yet upbeat, work environment.
• Rising was named a Top Workplace in the healthcare industry for 2023.
• We’re on YouTube! Check out our culture at http://www.youtube.com/user/RisingMedical.
• Check out our social media channels:
  • Facebook: https://www.facebook.com/RisingMedicalSolutions
  • LinkedIn: http://www.linkedin.com/company/rising-medical-solutions
  • Glassdoor: http://www.glassdoor.com/Overview/Working-at-Rising-Medical-Solutions- EI_IE322608.11,35.htm pages

If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!