Provider Relations - Established, Growing Medical Cost Containment Co.

Help us protect the financial health of healthcare!!!

Are you a sharp, technical and polished communicator with experience in the world of medical claims, insurance or billing and coding?

Come work for an established, progressive and fast-growing medical cost containment company headquartered on the north bank of the Chicago River.

Rising Medical Solutions, Inc. is seeking a Provider Relations Specialist to help maximize client savings by appropriately responding to providers who appeal Rising's medical bill re-pricing settlements.

This team member will:Conduct medical bill re-evaluation reviews and oversee all related activities necessary for timely and appropriate responses to medical provider requests for re-consideration. Research 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 decisions. Make a strong case for why certain bill reductions were taken and defend the company's actions through clear written and verbal communications. Identify and document bill review staff training needs, develop training guidelines, serve as coding Subject Matter Expert in training program development. Serve as back-up for coding review and provider negotiation functions. Identify, document and fix bill review software (PowerTrak) inconsistencies, errors, and problems. Research and answer complex questions regarding CPT, ICD-9, HCPCS, and other codes, fee schedules, PPO applications, and other technical matters. Resolve errors as needed. Assist with negotiating PPO network contracting efforts as needed. Provide world-class customer service by promptly answering inquiries and questions from Rising staff and clients. Assume responsibility for ongoing job skills training and professional development. Stay abreast of industry trends and developments. Assist with Quality Assurance (QA) checks.

Requirements:Bachelors Degree required CPC (Certified Professional Coder), CCS (Certified Coding Specialist) or equivalent medical coding certification a plus 2-3 years of medical claims adjusting and/or analysis, preferably in workers compensation Previous medical billing and coding instructional experience strongly desired Understanding of medical bill coding/review/processing required; other medical management/health care/insurance industry experience a plus Technical knowledge of healthcare billing procedures, documentation, and standards Thorough understanding of the complex inter-relationships between CPT codes/modifiers, ICD-9 codes, HCPCS codes, and medical terminology Ability to research, interpret, catalog, and retrieve case law Analytical, problem-solving, and decision-making abilities Negotiation skills. Ability to stand by tough decisions and not "cave in" during intense debate Strong verbal and written communication skills Proven customer service skills, including the ability to calmly deal with potentially intimidating attorneys and medical providers

A detailed role description can be found at the following link to the job posting our website: http://www.risingms.com/job_detail.php?jid=45



For immediate consideration, please submit resume and cover letter along with salary requirements.