Nurse Auditor – Medical Bill Review (Remote)

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 culturally-diverse people and situations. Requirements • 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! Apply To This Job



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