Nurse Auditor - Medical Bill Review (Remote)
Not Disclosed•Full-TimeHybrid
location_onMonroe Harbor, 400, East Monroe Street, Jewelers Row, Loop, Chicago, South Chicago Township, Cook County, Illinois, 60603, United States
Have you ever looked at a medical bill and immediately noticed something was wrong? Were you itching to use your expertise to fix it? We've been there, too. In fact, that's how our business was born—and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment.
Join our team and maximize client savings by reviewing medical bills from a nurse perspective. We pride ourselves on outstanding customer service and work hard to keep our impeccable reputation in the industry. In this role, you'll be a part of our mission by giving clients the information they need to determine case value based on the evaluation of medical records and billing statements. All while maintaining a human touch, you will demonstrate sensitivity to culturally diverse people and situations.
We offer a flexible hybrid schedule with in-office days reserved for training and collaborative meetings. Our firm is committed to core values, staff development, emerging technology, private ownership, and controlled growth. We frequently promote from within, offering a relaxed yet upbeat work environment. For those in the office, enjoy a casual dress code and unlimited coffee.
We consider qualified applicants regardless of background.
Work location
Work model: Hybrid
Monroe Harbor, 400, East Monroe Street, Jewelers Row, Loop, Chicago, South Chicago Township, Cook County, Illinois, 60603, United States
Chicago, Illinois
Key Responsibilities
- check_circleInitiate appropriate contacts with clients and medical providers as necessary
- check_circleNegotiate bills and conduct re-evaluation reviews as required
- check_circleReview medical bills from a nurse perspective to ensure billing, coding, and fee schedule compliance
- check_circleAudit medical and billing records to determine if services provided are reasonable, appropriate, and necessary
- check_circleClinically identify and evaluate charges not related to the specific occurrence
- check_circleVerify that charges align with services ordered and authorized
Requirements
- verifiedRN or LPN with active professional license
- verifiedCPC and/or CPC-H certification preferred
- verifiedSpecialized training in hospital coding, ortho, neuro, rehab, or ER procedures
- verified3-5 years of clinical experience in acute care, surgery, or orthopedic
- verifiedUnderstanding of CPT and ICD-10 codes and Medicare guidelines
- verifiedAbility to apply knowledge to state fee schedules
Nice to Have
CPC and/or CPC-H certification(s). Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures. Workers' Compensation medical bill review experience. Experience in any deposition or litigation cases.
Benefits & Perks
check_circleHealth insurancecheck_circle401(k) with company matchcheck_circlePaid time offcheck_circlePaid holidayscheck_circleFlexible hybrid schedulecheck_circleCasual dress codecheck_circleUnlimited coffee
Similar Job Opportunities
Frequently asked questions about Nurse Auditor - Medical Bill Review (Remote) at Rising Medical Solutions
What does a Nurse Auditor - Medical Bill Review (Remote) at Rising Medical Solutions do?expand_more
Day-to-day, the Nurse Auditor - Medical Bill Review (Remote) at Rising Medical Solutions will initiate appropriate contacts with clients and medical providers as necessary; negotiate bills and conduct re-evaluation reviews as required; review medical bills from a nurse perspective to ensure billing, coding, and fee schedule compliance; and audit medical and billing records to determine if services provided are reasonable, appropriate, and necessary.
What are the requirements for this Nurse Auditor - Medical Bill Review (Remote) role?expand_more
To qualify for the Nurse Auditor - Medical Bill Review (Remote) at Rising Medical Solutions position, applicants should have: RN or LPN with active professional license; CPC and/or CPC-H certification preferred; Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures; 3-5 years of clinical experience in acute care, surgery, or orthopedic; Understanding of CPT and ICD-10 codes and Medicare guidelines; and Ability to apply knowledge to state fee schedules.
Where is the Nurse Auditor - Medical Bill Review (Remote) role at Rising Medical Solutions located?expand_more
Nurse Auditor - Medical Bill Review (Remote) at Rising Medical Solutions is based in Monroe Harbor, 400, East Monroe Street, Jewelers Row, Loop, Chicago, South Chicago Township, Cook County, Illinois, 60603, United States. This is a hybrid role.
Is this Nurse Auditor - Medical Bill Review (Remote) job remote, hybrid, or on-site?expand_more
Rising Medical Solutions has listed this Nurse Auditor - Medical Bill Review (Remote) role as hybrid.
How much experience is required for this Nurse Auditor - Medical Bill Review (Remote) role?expand_more
Nurse Auditor - Medical Bill Review (Remote) at Rising Medical Solutions typically requires 3–5 years of relevant experience at the mid level level.
What skills do you need for the Nurse Auditor - Medical Bill Review (Remote) role at Rising Medical Solutions?expand_more
Key skills for Nurse Auditor - Medical Bill Review (Remote) at Rising Medical Solutions include RN; LPN; CPC; CPC-H; Hospital Coding; Ortho; Neuro; and Rehab.
What category does the Nurse Auditor - Medical Bill Review (Remote) role belong to?expand_more
Nurse Auditor - Medical Bill Review (Remote) at Rising Medical Solutions is part of the healthcare & nursing job category on Recrutus.
About Rising Medical Solutions
Rising Medical Solutions operates as a national managed care firm based in Chicago, IL, specializing in medical cost containment and care management services. The company serves the workers' compensation, auto, liability, and group health markets. Its client roster spans insurance carriers, third-party administrators, self-insured employers, and public-sector entities ranging from small organizations to large tier enterprises. Since its founding in 1999, the firm has reported saving billions in claim costs and impacting hundreds of thousands of employee lives across the United States.
The organization offers a comprehensive suite of services extending beyond standard bill repricing. Its flagship bill review technology consistently achieves over 60% in national savings through fee schedule application, network discounts, nurse audits, provider negotiations, and fraud detection. The proprietary VISION™ platform stands out as a multi-product, multi-line enterprise system allowing single-sign-on access for claims professionals. This tool supports ancillary referral and medical management capabilities throughout the entire care continuum, from early intervention to payment processing.
In addition to operational services, Rising Medical Solutions directs the annual Workers' Compensation Benchmarking Study. Launched in 2013, this research program analyzes complex forces affecting claims management and has become a frequently cited publication in the industry. The company continues to support the sector through various articles, webinars, and conference presentations derived from this data.
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