Strategic Bill Review Analyst - Workers' Compensation

Rising Medical Solutions•Milwaukee, WI

About The Position

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.

Requirements

High School Diploma required
Minimum one to three years of medical bill review/auditing and/or medical bill negotiation, or equivalent combination of education and experience
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

Nice To Haves

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.
Other medical/health care/insurance industry experience a plus

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 them 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.