Role Description The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. Essential Functions & Responsibilities: - Collects supporting data and analyzes information to make decisions regarding accuracy of billing - Appropriately documents work and final conclusions in designated computer program - Understanding of Surgical Implants - Meets department's expectations and standards - Additional duties as assigned Qualifications - Understanding of Itemization Review for designated clients - Understanding of CERIS systems and Data Base informatics - Understanding of HIPAA regulations - Exceptional organizational skills with the ability to handle stressful situations and adapt accordingly - Demonstrated leadership skills; ability to work with Leadership Team(s) within a positive team environment - Strategic problem solving, analytical, and critical thinking skills - Effective written and verbal communication skills - Ability to work independently and within a team environment - Proficiency with Microsoft Office Suite, including Excel, Outlook, Teams Requirements - Must maintain current licensure as a Registered Nurse in the state of employment - Must have a minimum of 5 years’ experience in the O.R., ICU, or E.R. as an R.N. - Associate Degree in Nursing or higher - Experience in medical bill auditing preferred but not mandatory Benefits - Comprehensive benefits package for full-time regular employees - Medical (HDHP) w/Pharmacy - Dental - Vision - Long Term Disability - Health Savings Account - Flexible Spending Account Options - Life Insurance - Accident Insurance - Critical Illness Insurance - Pre-paid Legal Insurance - Parking and Transit FSA accounts - 401K - ROTH 401K - Paid time off Company Description CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

• Plan and conduct external audits for manufacturing auditing systems • Evaluate compliance against documented processes and identify nonconformities, risks and improvement opportunities • Produce clear, accurate audit reports and verify the effectiveness of corrective actions • Maintain audit schedules, records, and documentation in line with accreditation requirements • Champion a strong customer service and quality culture while ensuring compliance with SGS policies and integrity standards

Role Description This role will provide coding quality auditing services to ensure compliance with Optum and CMS coding guidelines and accuracy of coding data reported. Must maintain compliance with Optum Coding Guidelines/policies. The minimum productivity goal is set by project, with minimum 96% coding accuracy rate required. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Assists with execution of the daily activities of the National Quality Assurance program - Performs first level quality audits on vendor coding results - Performs first level quality audits on Care Delivery coding teams coding results - Provides support and assists all markets within Care Delivery on various coding initiatives, such as concurrent review, query compliance audits and retrospective coding quality reviews - Must be able to work with multiple coding tools and EMR systems - Ensure that Optum Coding Guidelines are consistently applied in all processes - Identifies issues and trends in coding and documentation that affect coding accuracy - Provides input and valuable feedback on audit results - Recommends process improvement - Perform all other related duties as assigned You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Qualifications - Coding Certification required (CPC, COC, CIC, CCS, CCS-P, or RHIT; the CPC-A or CCA designation is not acceptable) - 4+ years of recent experience ICD-10-CM coding, preferably in a Managed Care setting, with solid attention to detail, and proficient knowledge of ICD-10-CM coding guidelines. - 2+ years of recent Medicare Risk Adjustment experience (HCC coding) with proficient knowledge of CMS HCC model and guidelines - 1+ years of recent experience in a coding auditor role– auditing the work of other coders - Compliant Physician query experience/knowledge - Ability to work during normal business hours, Monday-Friday 8am-5pm CST (flexibility to select an earlier or later shift start time, after successful completion of training) - Ability to continuously meet the requirements for a telecommuter, i.e. live in a location that can receive a UnitedHealth Group approved high speed internet connection, have a secure designated office space to maintain PHI, smartphone/device for Multi Factor Authentication purposes, meet or exceed all performance expectations Preferred Qualifications - CRC (Certified Risk Coder) in addition to required coding certification - Inpatient coding experience - Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook) - Excellent organizational, problem solving, and critical thinking skills - Excellent verbal/written communication and interpersonal skills Benefits - Comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) - Hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

Role Description The surgical billing specialists provide a variety of analytical, clinical, coordination, and technical duties for Perioperative Services. The surgical billing specialists are responsible for accurately charging patients in Perioperative Services. Interdepartmental and intradepartmental communication skills are essential. - Verifies schedule for charge reconciliation. - Uses multiple tools to count cases and ensures lapsed case times match. - Investigates any discrepancies. - Verifies documentation and assigns correct level charge to each procedure using clinical knowledge and experience. - Assigns each procedure a charge level based on equipment, personnel required, and supply usage. - Uses guide and experience to ensure most appropriate level is charged. - Reconciles charges using various reports, personal experience, and knowledge of cases. - Communicates in a professional manner with staff, ANM's, vendors, finance, and Materials personnel to gain any additional information needed to charge a case. - Produces and understands reports related to charge generation. - Uses technical and analytical skills while researching in multiple systems (CPM, Compurecord, HealthSpan, Lawson, and any other required) for verification purposes. - Maintains knowledge of technology (supplies, techniques, and procedures) to ensure appropriate charges are applied. - Reviews and verifies vendor contracts. - Verifies and consolidates contracts, receiving reports, and OR documentation. - Ensures all items are approved by appropriate management personnel or in value analysis committee. - Provides education to staff. - Conducts in-service education for OR staff and as required for support personnel. - Participates in orientation of new clinical staff. - Performs other related responsibilities as requested or required. - Performs in accordance with accepted procedure and responds to special requests by management in a timely manner. - Some other responsibilities including answering phone, setting up files and typing. - Demonstrates Service Excellence. - Adheres to policies and procedures. - Attends regularly scheduled staff meetings and in-service classes. - Uses tact and courtesy in all interactions with management, staff, patients, families, and vendors. Qualifications - High School plus 2 years or more of formal training/education. - Completion of approved Surgical Technology or Nursing program, applicable business training preferred. - 3 to 5 years operating room clinical experience required, previous business office or billing experience preferred. - May substitute 1 year of additional education (beyond approved 2 year RN or Surgical Technology) for 1 year of experience, up to 2 years. Requirements - Remote role (based out of Greenville, NC). - Monday - Friday day shift: 8:00 a.m. - 5:00 p.m. Pay Range $18.74 - $27.32/hr Benefits Great Benefits Company Description ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.