Nurse AuditorRising Medical Solutions
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:
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 a wide range of different people and situations.
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
