Strategic Bill Review Analyst – Workers' Compensation

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Review and organize responses related to litigation. Collaborate with various Operations teams to guarantee the accuracy of bill reviews, defend Rising's repricing strategies, and update processes as necessary.

• Serve as an expert witness when required for litigated cases, hearings, depositions, and fee coder affidavits.

• Foster innovation in bill review repricing strategies by ensuring the creation of workflows and maintaining appropriate documentation.

• Lead specialty bill review repricing strategies and product development, including but not limited to Rising Fair and Reasonable network reductions, Second Look, and the Rising Guarantee program.

• Thoroughly analyze specialty bill review bills and large medical bills, making payment recommendations based on claim history, medical notes, customary rates (UCR), state laws and fee schedules, available PPO contracts, coding guidelines, client instructions, and company policies.

• Enhance productivity through effective use of various software programs and reference tools, such as Vision, Smart Advisor, Excel, the Internet, and proprietary applications developed by the company.

• Communicate with medical providers to gather necessary information and address bill-specific issues.

• Interact directly with clients, providing exceptional customer service by promptly and professionally addressing their inquiries.

• Engage in ongoing training to improve job skills and knowledge.

• Mentor and provide training to less-experienced Auditors.

• Undertake special projects as assigned by management.

⛳️ Requirements

• A High School Diploma is required; an Associate or Bachelor’s Degree is preferred.

• Coursework or certification in CPC (Certified Professional Coding) is highly advantageous.

• CPC certification must be obtained within two years of starting the position.

• A minimum of one to three years of experience in medical bill review/auditing and/or medical bill negotiation, or a comparable combination of education and experience.

• Additional experience in the medical, healthcare, or insurance industries is a plus.

• Capability to read, analyze, and interpret technical procedures, medical reports, state laws, fee schedules, and CPT codes.

• Proficiency in effectively presenting information and responding to inquiries from peers, clients, and providers.

🏝️ Benefits

• Competitive base salary, profit sharing, 401k matching, generous time off, and opportunities for career advancement.

• A relaxed yet dynamic work atmosphere.

• Rising was recognized as a Top Workplace in the healthcare industry for 2023! Check out our profile here: Rising Medical Solutions, Inc Profile (topworkplaces.com).

• Explore our culture on YouTube at: http://www.youtube.com/user/RisingMedical.

• Want to see more? Visit our social media pages:

• Facebook: https://www.facebook.com/RisingMedicalSolutions

• LinkedIn: http://www.linkedin.com/company/rising-medical-sol...

• Glassdoor: http://www.glassdoor.com/Overview/Working-at-Rising-Medical-Solutions-EI_IE322608.11,35.htm