Nurse Auditor - Medical Bill Review (Remote)

About the role

Rising Medical Solutions is seeking a Nurse Auditor to join our team. This role involves maximizing client savings by reviewing medical bills from a nurse’s perspective, focusing on appropriate billing, coding, treatment, fee schedule compliance, over-utilization, and erroneous charges.

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 needed
• Negotiate bills and conduct re-evaluation reviews as required

Requirements

• RN (or LPN) with an 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
• Able to apply knowledge to state fee schedules
• A customer service orientation, including strong communication skills
• Experience in any deposition or litigation cases a plus

Qualifications

We are looking for a candidate who understands the importance of accurate medical billing and coding. You should have a strong background in nursing, preferably with a focus on acute care, surgery, or orthopedic bill review. Additionally, you should have a solid understanding of CPT and ICD-10 codes, as well as familiarity with Medicare guidelines.

Skills

• Strong clinical judgment and problem-solving skills
• Excellent attention to detail
• Effective communication and negotiation skills
• Ability to work independently and as part of a team

Benefits

• Competitive benefits package, including health insurance, 401(k) with company match, paid time off, paid holidays, and more
• Flexible hybrid schedule with in-office days reserved for training and collaborative meetings
• Opportunity to make a difference in reducing healthcare costs and increasing the value of healthcare to individuals and their employers
• A relaxed, yet upbeat work environment
• Casual dress code with unlimited coffee!

Pay

Details TBA

Schedule

Details TBA