• 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.

• Performing AML alert/case reviews, seeking to mitigate risks associated to financial crimes and suspicious activity. • Applying research and analytic techniques to digest complex information sets in order to make logical and adequately supported determinations in regard to unusual and potentially suspicious activity. • Applying consistent and well-documented analysis consistent with industry standards to ensure success in the following daily efforts of Transaction Monitoring. • Conducting an end-to-end and meticulous review of potential illegal or suspicious activity. • Completing a time-sensitive and meticulous analysis of each instance of potential Anti-Money Laundering activity and/or suspicious financial activity across multiple jurisdictions and countries. • Assessment of customer profiles and client data to identify whether activity is consistent with typical purchasing/payment activity, including Acceptable Use Policy adherence and Know Your Customer efforts. • Documenting findings in narrative style format, in the manual and automated process case management system and prepare updates to Project Managers / Team Leads as appropriate. • Make determinations for potential Suspicious Activity Report (SAR) filings.

• Investigate and respond to consumer complaints • Support internal and external fraud referrals and investigations • Perform agent monitoring and manage regulatory inquiries • Assist in reporting and contribute to policy development • Make recommendations for process improvements

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.