Apply📍 United States
🧭 Part-Time
🔍 Medical cost containment and care management
🏢 Company: Rising Medical Solutions
- 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.
- 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.
- Serve as a resource person to co-workers.
- Demonstrate sensitivity to culturally diverse people and situations.
- Continually improve job skills and maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research.
- Follow appropriate report formats and documentation guidelines.
- Perform other administrative or corporate duties upon request.
Communication SkillsAnalytical SkillsCollaborationCustomer serviceNegotiation
Posted 2024-10-15
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