Strategic Bill Review Analyst - Workers' Compensation
Milwaukee, Wisconsin, United States · Remote OK
Mid level
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Strategic Bill Review Analyst - Workers' Compensation
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Full-time
high school, associate degree, bachelor degree, professional certificate
Profit Sharing, 401k Matching, Generous Time Off, Career Growth Opportunities
Posted 40d ago
~40 hrs/week
Remote in Milwaukee, Wisconsin, United States
Responsibilities
The analyst is responsible for processing large medical bills by applying coding reviews, state laws, and fee schedules to maximize client savings. They also identify product trends, deliver financial reporting, and serve as an expert witness for litigated cases.
Requirements
A high school diploma is required, with an associate or bachelor's degree preferred and CPC certification required within two years. Candidates need one to three years of experience in medical bill review, auditing, or negotiation.
Full job description
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.
Core Responsibilities include:
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.
High School Diploma required, 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.
Minimum one to three years of medical bill review/auditing and/or medical bill negotiation, or equivalent combination of education and experience
Other medical/health care/insurance industry experience a plus
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
Competitive base salary, profit sharing, 401k matching, generous time off, and career growth opportunities
A relaxed, yet upbeat, work environment
Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Rising Medical Solutions, Inc Profile (topworkplaces.com)
Rising Medical Solutions is a national managed care firm that provides medical cost containment and medical care management services to the workers' compensation, auto, liability, and group health markets. Our client base includes insurance carriers, TPAs, self-insured employers, and public-sector and government entities of varying sizes from small to large tier.
Since 1999, our managed care services have positively impacted hundreds of thousands of employee lives and saved billions in total claim costs for payers across the country. Our flagship bill review service and technologies consistently deliver over 60% in national bill review savings, which includes application of fee schedule/UCR rates, network discounts, nurse audits, provider negotiations, and embedded fraud detection capabilities.
However, our solutions portfolio goes far beyond the standard repricing of medical bills. Our integrated programs deliver clinical and cost-saving expertise before, during, and after treatment. Our proprietary VISION™ platform is the industry’s only multi-product, multi-line, single-sign-on, medical management enterprise system. VISION™ provides claims professionals with unprecedented ancillary referral and medical management capabilities across the entire medical care continuum, from early intervention to payment processing. Together with our passionate, mission-driven employees, Rising delivers an unparalleled user experience for those providing, receiving, and paying for medical care.
Rising also directs and publishes the annual Workers’ Compensation Benchmarking Study, a national research program examining the complex forces impacting claims management in workers’ compensation today. The study has become one of the most cited research publications in the industry and has been the subject of numerous articles, webinars, and conference presentations since its 2013 inception.
Offices: 325 N LaSalle Street, Suite 600, Chicago, IL 60654, US · 700 West Virginia Street, Milwaukee, WI 53204, US
Medical Cost ContainmentMedical Bill NegotiationMedicare Set Aside Workers CompensationUtlization Review ServicesMedicare Set Aside AdministrationMedical Bill ReviewHospital Bill ReviewMedicare Set Aside Trustand Utilization Review Workers CompensationHealth Care
How many Legal jobs are open in Milwaukee, WI right now?
There are currently 101 open legal positions in Milwaukee, WI listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Legal roles in Milwaukee, WI?
Companies currently hiring include Husch Blackwell, Northwestern Mutual, Expert Institute, American Addiction Centers, Baird, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Legal jobs in Milwaukee, WI?
Yes — 53 of the 101 open legal positions offer remote or hybrid work (22 remote, 31 hybrid).
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