Job Description:

As our Director of Specialty Bill Review Services, you will maximize savings and client satisfaction by providing strategic direction for Rising's Specialty Services unit involving complexlarge medical claims; analyzing and optimizing bill review procedures and systems; and leading a team of experienced medical bill review auditors, nurse auditors, med-legal nurse, negotiators and related staff in an environment of continual performance improvement.Here's What You'll Be DoingAct as Operations SME for capturing savings and fee allocation to optimize revenueParticipate in ongoing training to enhance own job skills, knowledge, and professional growth. Keep informed on issues and trends relating to Healthcare, Workers Compensation, Bill Review, Cost Containment, Managed Care, and related areasCollaborate with other members of Rising's management team to support core values and achieve company objectivesMonitor changes in State and Federal laws, rules or fee schedules that impact medical bill reviewre-pricing and ensure they are integrated into workflows (and Smart Advisor via Mitchell) for proper adjudicationHelp develop medical bill re-pricing guidelines and procedures to address any legal ambiguities, or situations where no applicable rules or fee schedules existWork with Tech Operations to help develop system rulesautomation that reduce and minimize manual processesManagesoversees Test Bills for prospective clients to maximize savingsParticipate in prospective client presentationsResearch and build a library of case law (particularly regarding state-specific jurisdictional workers compensation issues) that can be drawn from to assist in provider negotiations and to defend company medical bill re-pricing decisionsPrepare legalsettlement assessments, manage litigationbill disputes, respond to defense attorney requests, and provide testimony as an expert witness as requiredResearch and answer complex questions regarding CPT, ICD-9, HCPC and other codes, fee schedules, PPO applications, and other technical matters. Resolve errors as neededProvide world-class customer service by promptly answering inquiries and questions from Rising staff and clientsSpecial projects as assigned by executive managementRequirementsCollege degree required, with an emphasis in finance, business, or operationsCPC (Certified Professional Coding) certification or equivalent requiredMinimum five years of financial analysisbusiness, medical claims adjusting background preferably in Workers Compensation with progressive management responsibilityExperience in medical bill review, CPT coding, and cost containment strongly preferredIn-depth understanding of Workers Compensation rules and regulations requiredSupervisory and managerial skills"”able to bring out the best in othersStrong oral and written communication skillsStrategic thinker with an ability to translate plans into actionAbility to understand complex issues, identify opportunities, and recommend appropriate solutionsExcellent project managerTechnical knowledge of healthcare billing procedures, documentation, and standardsThorough understanding of the complex inter-relationships between CPT codesmodifiers, ICD-9 codes, HCPCS codes and medical terminologyAbility to research, interpret, catalog, and retrieve case lawAnalytical, problem solving, and decision-making abilitiesAbility to organize resources and establish prioritiesProven customer service skills, including the ability to calmly deal with potentially intimidating attorneys and medical providersA desire to continue to learn and improve both self and the organizationBenefitsA relaxed, yet upbeat, work environment with a jeans professional dress codeGenerous Flexible Time Off (take it when you need it!)Competitive base salary, benefits, 401k matching, and more! Career Growth Opportunities (we often promote from within!)Daily interaction with some of the most talented people in the medical cost-containment industryRising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Rising Medical Solutions Profile () We're on YouTube! Check out our culture at: (48) RisingMedical - YouTube Want to see more? Check out our: Facebook: Rising Medical Solutions | Chicago IL | Facebook LinkedIn: (29) Rising Medical Solutions: My Company | LinkedIn Glassdoor: OverviewWorking-at-Rising-Medical-Solutions-EI_IE322608.11,35.htm