Rising is hiring a
Nurse Auditor

Summary

Rising Medical Solutions is seeking a part-time Nurse Auditor with 3-5 years of clinical experience in acute care, surgery, or orthopedics. The role involves auditing medical bills, negotiating bills, and maintaining a human touch while adhering to quality standards and confidentiality. Remote position available.

Requirements

RN (or LPN) with active professional license or equivalent within states of operation

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
• Consistently meet productivity and turn-around time requirements
• Adhere to quality standards, state billing guidelines, HIPAA rules, and confidentiality of all information, policies, and procedures
• Negotiate bills and conduct re-evaluation reviews as required
• Conduct re-evaluation reviews as required
• Serve as a resource person to co-workers

Preferred Qualifications

• 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

• Remote position
• 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
• You will be part of our new Elevate program designed to recognize and reward employees for their hard work