Jobs at MedRisk

Leads business requirements analysis and product management for PPO healthcare products. Translates stakeholder needs into business requirements, functional specifications, product roadmaps, and release priorities. Coordinates with development, QA, compliance, vendors, and clients on integrations, implementations, testing, regulatory requirements, and issue resolution. Provides analytical support, facilitates project meetings, manages product quality and delivery, and serves as a PPO domain expert.

Leads large-scale workers’ compensation bill review operations, overseeing service delivery, client satisfaction, workforce planning, process optimization, budgets, and business growth. Manages multiple leadership layers and operational teams while establishing performance goals, monitoring service metrics, driving automation and AI initiatives, and partnering with technology, product, quality, compliance, sales, and clients. Requires extensive healthcare, claims, payment integrity, or medical bill review leadership experience.

Reviews and processes bills for accuracy, completeness, and compliance with applicable billing guidelines. The role likely identifies discrepancies, validates charges, and supports timely resolution of billing issues. Specific responsibilities and qualifications were not provided in the job description.

Researches complex billing, claims, and reimbursement issues to support accurate revenue collection. The analyst identifies trends, reports workflow opportunities, proposes process improvements, documents resolutions, meets productivity standards, and protects patient account confidentiality under HIPAA guidelines.

Reviews, audits, and approves workers compensation and no-fault medical bills using fee schedules, PPO interfaces, client instructions, and the Medata system. Analyzes medical records, coding, terminology, billing history, and usual-and-customary applications to recommend payment. Maintains productivity, accuracy, and turnaround-time standards; performs quality reviews; researches billing issues; and escalates system or process concerns.

Provides inbound phone support to providers and collection staff regarding claim status. Explains billing processes and timing, coordinates with internal departments to resolve inquiries, meets customer service and quality standards, maintains agent availability goals, follows procedures, identifies system or process issues, and completes assigned tasks.

The Client Solutions Manager oversees project management for client projects, coordinating with business and tech teams while ensuring effective communication and deliverables adherence. Responsibilities include gathering requirements, managing workflows, and maintaining project timelines.

The Revenue Operations Strategy Manager will develop operational strategies, improve processes, and collaborate with various departments to enhance efficiency and meet company goals.

The job description only identifies a Director of Network Development position and provides no details about responsibilities, qualifications, technologies, compensation, travel, or work authorization.

Lead development of long-term revenue operations strategies, analyze and optimize processes, partner with Product Management and leadership to define tech requirements, act as a BI/Qlik SME, implement operational changes, monitor success metrics, and champion cross-functional initiatives to improve efficiency and reimbursement and billing accuracy.

Analyze and resolve billing, claims, and reimbursement issues to ensure accurate, timely revenue receipt. Identify trends, report patterns to management, propose workflow improvements, document resolutions, meet production standards, and maintain HIPAA confidentiality for patient accounts.