Job Description • 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! Apply To This Job