Rising Medical Solutions

• 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.

Title: Compliance Manager - Remote Location: USA- Job Description: The Compliance Manager supports Rising Medical Solutions’ corporate compliance program by ensuring adherence to federal, state, and industry regulatory requirements across managed care, bill review, utilization review, provider networks, and case management. This role oversees multi‑state managed care programs, including MPN, MCO, bill review, and timely pay compliance, and leads regulatory filings, renewals, reporting, and customer implementations. The Compliance Manager monitors legislative and regulatory developments impacting managed care and medical billing operations and serves as a key liaison with regulatory agencies, customers, and internal stakeholders. This position acts as a regulatory subject‑matter expert, supporting organizational compliance with state‑specific workers’ compensation laws, administrative rules, and accreditation standards while promoting operational integrity and effective communication. Core Responsibilities include: Regulatory and Compliance - Monitor and analyze state and federal regulatory developments, legislation, and industry trends governing workers compensation affecting Rising’s lines of business - Independently research, track, and assess regulatory impact on managed care, bill review, and timely pay operations - Communicate regulatory changes to internal teams and customers - Provide input and subject matter expertise in the development of corporate compliance training materials. - Support clinical operations to maintain and support URAC certification and reaccreditation. Managed Care and Filing Requirements - Manage certified managed care programs (MPN/MCO), including state filings, renewals, amendments, and reporting - Serve as primary contact with state regulatory agencies regarding filings, audits, deficiencies, and inquiries - Lead implementation and rollout of customer managed care programs - Maintain historical archives and resource documentation for state filings and customer materials. - Provide support for state UR certification processes, including renewals and compliance monitoring, and URAC certification - Develop and maintain managed care resource materials for Rising state filings and customer worksite materials - Oversee the coordination of resources to ensure the ongoing effectiveness of the state managed care programs - Monitor state regulatory sources for provider suspensions, exclusions, arrests, and fraud‑related actions affecting workers’ compensation participation - Direct validation of provider TIN/NPI data, ensure fraud flags are entered in Vision, and oversee timely alerts to bill review and utilization review teams when exposure is identified Management of MPN - Lead and manage the MPN Coordinator team, ensuring consistent application of MPN rules, compliance standards, and service expectations · Oversee provider compliance, including credentialing changes, suspensions, fraud monitoring, and continuity of care - Monitor workload distribution and completion of MPN scheduling tasks to ensure service level expectations are met - Provide coaching and performance oversight to support timely, accurate responses to MPN requests from injured workers, customers, adjusters, and attorneys - Review geo‑access analysis and direct corrective actions to address network coverage gaps; serve as escalation point and backup responder as needed Corporate Compliance Program Leadership - Maintain regulatory documentation, dashboards, trackers, and compliance materials - Support RFP responses related to managed care, bill review, timely pay, and regulatory compliance - Manage cross-functional projects through planning, research, implementation, and audit review - Support maintenance of Business Continuity Plans and Disaster Recovery Plan and ensure their updates Reports to: Director of Corporate Compliance Requirements - Bachelor' s degree in business administration or related field and ten (10) years significant business experience, or ten (10) years of industry experience - Significant experience in research and interpretation of Workers' Compensation state managed care plans and medical bill review requirements - Proven ability to manage multiple projects and deadlines in a regulated environment - Experience working with regulatory agencies, customers, and internal operational teams - Ability to interpret legislation and translate regulatory requirements into operational guidance - Excellent attention-to-detail, planning, and follow-through skills - Critical thinking and problem-solving skills - Must be a self-starter, flexible, customer-focused, and have a professional demeanor - Ability to work independently and as part of a team - Knowledge of industry regulations, terminology, principles, and practices; familiarity with legal reference materials, and thorough understanding of research techniques - Proficiency with Microsoft Office applications, SharePoint, Office 365 - Excellent oral and written communication skills - Excellent organizational/time management skills - Experience writing briefs and/or position papers Benefits - Health insurance (4 different plans to choose from) - Dental - Vision - Paid time off (PTO) or Flexible Time Off (FTO) - 401(k) - Basic Life Insurance and Long-Term Disability Insurance (paid by the company) - Voluntary Life Insurance and Short-Term Disability Insurance - Flexible Spending Accounts (FSA) - Employee Assistance Program (EAP) - Rise Well Wellness Program - Professional Development Reimbursement Program (PDRP) - You will be part of our new Elevate program designed to recognize and reward employees for their hard work

• 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.

Role Description As our Telephonic Nurse Care Manager, you will coordinate all aspects of patient care for high-risk individuals. You will evaluate each patient while directing treatment plans, discuss claims, benefits, and eligibility, and manage resources while working alongside patients, their families, and other medical professionals. - Establish collaborative relationships and act as an intermediary between clients, patients, employers, providers, and attorneys. - Assess, coordinate, implement, monitor, and evaluate the plan to meet the injured/disabled individual’s needs, utilizing the knowledge of medical necessity, care appropriateness, and managed care principles. - Promote quality, cost-effective care throughout the health continuum to ensure the injured/disabled individual is able to return to an optimal level of work and functioning and documenting case savings. - Document ongoing progress of all case management activity, including the organized maintenance of files containing clinical documentation of interactions with all parties of every claim. - Assess injury severity, extent of disability, treatment plans, functional abilities, and physical job requirements to establish return to work plans and strategies to manage future medical exposure. Qualifications - An RN License preferably in a compact state AND with an IL license. - California RN license a plus. - At least 3 years of TCM experience preferred. - Experience with Workers’ Compensation or Disability Management. - Having your BSN, CCM, and/or any other insurance/workers’ compensation certifications is a huge plus! - Associate degree. Requirements - Strong computer skills required – Microsoft Suite (Outlook, Excel, Word, etc.). - The ability to maintain confidentiality of all information, policies, and procedures. - The ability to set priorities and work both autonomously and as part of a team. - Demonstrated sensitivity to culturally diverse people and situations. - Well-developed time management, organization, and prioritization skills. - Knowledge of utilization management, case management, and healthcare provided throughout the health continuum. - Excellent oral and written communication skills with a heavy focus on customer service. - 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. - The ability to stay calm during stressful situations. Benefits - Competitive base salary, profit sharing, 401k matching, generous time off, and career growth opportunities. - A relaxed, yet upbeat, work environment.

• Evaluate liability demand packages, including medical records, billing, and treatment timelines to identify gaps, inconsistencies, and cost drivers • Utilize evidence-based guidelines (ODG, MCG, InterQual, etc.) to determine authorization versus escalation to Peer or Physician Review • Review and analyze past and projected cost of medical treatment. • Document appropriately in Rising’s systems (and client systems as needed), and issue demand package review report • Write clear, concise, and defensible nurse summaries on all UR and demand review files. • Establish and maintain collaborative relationships with clients, attorneys, and internal stakeholders

• Evaluating liability demand packages, including medical records, billing, and treatment timelines to identify gaps, inconsistencies, and cost drivers • Utilizing evidence-based guidelines (ODG, MCG, InterQual, etc.) to determine authorization versus escalation to Peer or Physician Review • Reviewing and analyzing past and projected cost of medical treatment. • Documenting appropriately in Rising’s systems (and client systems as needed), and issuing demand package review report • Writing clear, concise, and defensible nurse summaries on all UR and demand review files. • Establishing and maintaining collaborative relationships with clients, attorneys, and internal stakeholders