Rising Medical Solutions

• 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.

Role 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. - 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. Qualifications - 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. Benefits - Competitive base salary. - Profit sharing. - 401k matching. - Generous time off. - Career growth opportunities. - A relaxed, yet upbeat, work environment.

Nurse Auditor - Medical Bill Review (Remote) Remote3500 Technical AssuranceFull time20260601 Chicago, Illinois, United States Overview Description Have you ever looked 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, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and erroneous charges. 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 evaluation of medical records and medical billing statements, and will: - 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 appropriate and necessary. - Negotiate bills and conduct re-evaluation reviews as required All while maintaining a human touch, demonstrating sensitivity to culturally-diverse people and situations. Requirements - RN (or LPN) with 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 - Ability to apply knowledge to state fee schedules - A customer service orientation, including strong communication skills - Experience in any deposition or litigation cases a plus 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 - Employment within a firm committed to core values, staff development, emerging technology, private ownership, and controlled growth/reinvestment in the future - we frequently promote from within! - Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers. - A relaxed, yet upbeat work environment - And for those in the office: casual dress code with unlimited coffee!

Role Description Rising Medical Solutions has an opening for a Utilization Review Nurse, and we want to hear from you! We're a bill review and cost containment company - so what does that mean? Basically we are trying to fix a very broken healthcare system by reducing the cost of healthcare claims through bill review, case management, and utilization review. Our mission is "To make lives better" and everyone here at Rising works hard to achieve this goal. This is a full-time position - 40 hours per week (Must work M-F each day). Responsibilities - Perform all aspects of the Utilization Review Process - Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone - Utilize evidence-based guidelines to determine if authorization can be given versus having to send the file or for Peer or Physician Review - Write nurse summaries on all UR files - Document properly in Rising's database (and client data bases when appropriate), and send determination letters on each completed UR - Establish collaborative relationships with clients, patients, employers, providers and attorneys - Track ongoing status of all UR activity so that appropriate turn-around times are met - Maintain organized files containing clinical documentation of interactions with all parties of every claim - Utilize good clinical judgment, careful listening, and critical thinking and assessment skills - Respond to various written and telephonic inquiries regarding status of case - Must be proficient in the use of a computer, including the use of various software programs simultaneously Qualifications - An Associate's or Bachelor's degree in Nursing - Hold an active and unencumbered RN license in one or more states - 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience - More than one state license (a plus) - Experience with Workers' Compensation, short-term or long-term disability, or liability claims - The ability to set priorities and work both autonomously and as a team member - Well-developed time-management, organization, and prioritization skills - Excellent analytical skills - Superb oral and written communication - The ability to gather data, compile information, and prepare summary reports - Strong interpersonal and conflict resolution skills - Experience in a fast-paced, multi-faceted environment - Demonstrated persistence and attention to detail - General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines - Working knowledge of: Microsoft Word, Excel, and Outlook - Ability to remain calm during stressful situations - A customer-service mindset Benefits - Generous Flexible Time Off (take it when you need it!) - Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matching - Career Growth Opportunities - We often promote from within - Professional Development Reimbursement Program (PDRP) - You will be part of our new Elevate program designed to recognize and reward employees for their hard work

• 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 appropriate and necessary. • Negotiate bills and conduct re-evaluation reviews as required • All while maintaining a human touch, demonstrating sensitivity to culturally-diverse people and situations.

• Translate business requirements into technical requirements and ensure all system requirements adequately reflect defined business processes and fully support all components of the functional business requirements • Communicate requirements and collaborate with developers, QA analysts, and other project team members to implement or enhance systems • Represent Rising in client and partner meetings for system implementations • Develop a subject matter expertise on one or more aspects of integrations between company and external systems and/or internal systems • Assist with production support - investigate issues, root cause analysis, report and communicate detailed findings when necessary • Develop use cases and process/data flow diagrams • Support the creation and/or create test plans and relevant training materials • Conduct reviews of systems and identify enhancements that support company strategies and affect key performance indicators • Conduct training for other Professional Services team members for subject matter knowledge transfers

Role Description Rising Medical Solutions has an opening for a Systems Analyst II, and we want to hear from you! What You'll Be Doing: - Translate business requirements into technical requirements and ensure all system requirements adequately reflect defined business processes and fully support all components of the functional business requirements. - Communicate requirements and collaborate with developers, QA analysts, and other project team members to implement or enhance systems. - Represent Rising in client and partner meetings for system implementations. - Develop a subject matter expertise on one or more aspects of integrations between company and external systems and/or internal systems. - Assist with production support - investigate issues, root cause analysis, report and communicate detailed findings when necessary. - Develop use cases and process/data flow diagrams. - Support the creation and/or create test plans and relevant training materials. - Conduct reviews of systems and identify enhancements that support company strategies and affect key performance indicators. - Conduct training for other Professional Services team members for subject matter knowledge transfers. Qualifications - A Bachelor’s degree or equivalent, preferably in an IT-related field. - A minimum of two full years of experience in a business systems analyst or equivalent role. - Must have experience with workers’ compensation insurance, group health insurance, medical bill review, and/or relevant health care industry systems and processes. - Must have experience with requirements analysis, interacting with business users to define clear scope, and contributing to cross-functional teams. - Excellent analytical, communication, and problem-solving skills, and experience applying these skills to resolve application design considerations and technical issues. - Must have working knowledge of database and data modeling tools and concepts. - Must have working knowledge of business-to-business data transactions and experience writing detailed mapping instructions to transfer data between distinct models. - Must have experience analyzing XML or EDI messages. - Strong working knowledge of SQL and database concepts to aid in data analysis. - Ability to communicate technical information clearly and participate in collaborative meetings with representatives from internal departments and clients. - Skill in the use of computerized spreadsheet, relational database, and word processing software. - Ability to process computer data and to format and generate reports. - Must have experience creating detailed visual models to support requirements including data flow/workflow diagrams. - Ability to conform to shifting priorities, demands, and timelines. - Ability to quantify results in terms of cost savings and key performance indicators. - Demonstrated history of proactively identifying improvement opportunities in systems and methodologies. Benefits - Generous Flexible Time Off (take it when you need it!). - Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matching. - Career Growth Opportunities - We often promote from within. - Professional Development Reimbursement Program (PDRP). - You will be part of our new Elevate program designed to recognize and reward employees for their hard work.

Title: Medical Administrative Assistant Location: IL-Chicago Job Description: We are looking for a Medical Administrative Assistant to join our team! We are looking for a Medical Administrative Assistant to join our team! Are you someone who thrives in a fast-paced office environment where your time management, attention-to-detail, and communication skills are put to good use? Are you looking to switch from a hospital environment to remote office work? We might have the perfect entry/mid-level opportunity for you. Join our medically-based concierge service and early intervention program and help impact injured workers lives by coordinating services, providing resources to our constituencies, and helping people when they need it most. The Injury Coordinator (working title: Medical Administrative Assistant) works in a remote office setting to: - Manage and/or assign files to appropriate staff member and initiate appropriate verbal and/or written contacts with employers, clients, claimants, and medical providers. - Set up files in all appropriate systems; assign files, when applicable, to the nurse. - Maintain responsibility of an individual caseload. - Maintain appropriate electronic and paper files. - Interface with a variety of inter-disciplinary providers (e.g., PT, diagnostic, psychology, etc.). - Identify, maintain, and update participating providers. - Answer incoming calls, and direct the call appropriately. - Process all documents using computer, copier, and scanner. - Search and copy the appropriate internal criteria guidelines, when appropriate. - Work as part of a team to meet turn-around time for the set activity. - Keep supervisor advised of any problems or delays. - Continually improve job skills and knowledge of all company products and services as well as customer issues and needs, through ongoing training and self-directed research. - Adhere to company policies, procedures, and reporting requirements. Requirements - Experience in any of the following disciplines a plus – CNA, Medical Assistant, Physical Therapy Aide, Workers’ Compensation, Medical Unit Claims Administrator, IME Coordinator, Medical Office Manager - Experience with workers' compensation or disability (a plus!) - Bachelor's or Associate's Degree preferred but not required - Intermediate computer and internet skills (will work with programs including MS Word, Outlook, and Excel) - Basic knowledge of/ability to read medical reports - The ability to research evidence-based guidelines - An understanding of workflow guidelines and follow as necessary - Proficient verbal/telephone and written communication skills - A high level of efficiency, ability to maintain rapid workflow - An aptitude for learning, organization skills and the ability to follow systems and procedures - A time-management mindset, along with planning, and prioritization skills - The ability to work independently as well as part of a team - The ability to express empathy with injured and/or disabled people - A customer service mindset - Ability to work Monday-Friday on a 1st shift central time zone Benefits - Comprehensive benefit package including health/dental/vision insurance, profit sharing, 401k matching, generous time off - Traditional first shift schedule - A relaxed, yet upbeat, work environment, with a jeans professional dress code when onsite - In-office days reserved for training or team events - Awesome downtown location in River North - Close to public transit ns/)

• Provide planning and leadership on projects and client integrations to both internal and external customers • Translate business requirements into technical requirements and solutions • Represent Rising in client meetings regarding new business initiatives and/or changes • Utilize statistical concepts and quantitative methods to develop baseline measures, identify root cause and reduce and/or eliminate internal/external failures • Proactively identify improvement opportunities • Provide guidance to both the client and internal project members for the utilization of best practices and workflows efficient for both parties • Demonstrate ability to quantify results in terms of cost savings and impact on key performance indicators • Formulate use cases, process flows and training material on projects and client integrations • Support the creation of and/or create test plans and training materials relevant to the project • Collaborate with resources to ensure all system design requirements adequately reflect the defined business processes and fully support all components of the functional business requirements • Will oversee the Implementation Team, while working directly with senior leadership and other department heads

Role Description Join the Rising Medical Solutions Team for your chance to make your mark in the world of client implementation! Rising is looking for a leader who can use their broad skills spanning from client management to BA to further our mission in the medical cost containment field. Rising prides itself on progressive development and exceptional customer service, so join our team if you're looking to up your game! - Provide planning and leadership on projects and client integrations to both internal and external customers - Translate business requirements into technical requirements and solutions - Represent Rising in client meetings regarding new business initiatives and/or changes - Utilize statistical concepts and quantitative methods to develop baseline measures, identify root cause and reduce and/or eliminate internal/external failures - Proactively identify improvement opportunities - Provide guidance to both the client and internal project members for the utilization of best practices and workflows efficient for both parties - Demonstrate ability to quantify results in terms of cost savings and impact on key performance indicators - Formulate use cases, process flows and training material on projects and client integrations - Support the creation of and/or create test plans and training materials relevant to the project - Collaborate with resources to ensure all system design requirements adequately reflect the defined business processes and fully support all components of the functional business requirements - Will oversee the Implementation Team, while working directly with senior leadership and other department heads Qualifications - Bachelor's degree in technical or management field, or related experience - 5+ years' experience in Business Analysis or Project Management - Project Management Certification - Experience in workers’ compensation insurance, medical bill review or healthcare industry a strong advantage - Experience implementing client server and web-based applications - Experience interacting with business users to define clear scope and create and manage proper cross-functional teams - Experience working with project managing large scale custom software development projects - A strong working knowledge of business process reengineering and requirements analysis - Previous leadership experience a plus - A working knowledge of database and data modeling tools and concepts - Ability to communicate technical information clearly and lead collaborative meetings with representatives from internal departments and client companies - Ability to manage multiple projects at once - Ability to understand shifting priorities and make quick decisions - Ability to travel (up to 10%) Benefits - Competitive benefits package, including health insurance, 401(k) with company match, paid time off, paid holidays, and more. - Employment within a firm committed to core values, staff development, emerging technology, private ownership, and controlled growth/reinvestment in the future - we frequently promote from within! - Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers. - A relaxed, yet upbeat work environment.