Nurse Auditor - Medical Bill Review (Remote)
Rising Medical Solutions•Chicago, IL
•Hybrid
About The Position
Rising Medical Solutions is looking for a Nurse Auditor to join their team and maximize client savings by reviewing medical bills from a nurse perspective. This role involves evaluating appropriate billing, coding, treatment, fee schedule compliance, over-utilization, and erroneous charges. The position contributes to the mission of providing clients with the information needed to determine case value through the evaluation of medical records and billing statements.
Requirements
- RN (or LPN) with active professional license or equivalent within states of operation
- Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures
- 3-5 years of clinical experience in acute care, surgery and/or orthopedic
- 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
Nice To Haves
- CPC and/or CPC-H certification(s) strongly desired
- Workers’ Compensation medical bill review experience a major plus
- Experience in any deposition or litigation cases a plus
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.
Benefits
- health insurance
- 401(k) with company match
- paid time off
- paid holidays
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
