CERIS

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care. Clinical and/or technical expertise is utilized to addr...

The Account Executive is responsible for interacting with customers and prospects on an executive level and acting as an extension of the client; selling new services, understanding and communicating agreed upon expectations to all teams, and increasing the market share of busine...

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS ...

Responsible for managing daily production (file flow) of designated department, which may include one or more of the following functions: human resources, customer service, and promoting positive influence over Setup Analysts. This is a remote position. Responsible for implementi...

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. Collects supporting data and analyzes information to make decisions regardi...

The Provider Management Analyst is responsible for verifying provider information and requests for documentation to audit claims including but not limited to itemized bills, medical records, UB04’s, HCFA’s, etc. Responsibilities include verifying patient information, provider con...

The CERIS Certified Coder reverse codes previously coded medical bills to determine coding accuracy. This role is responsible for making claim-related recommendations and communicating status of the claim to involved stakeholders. This is a remote position. Receives claim and pro...

The Implementation Manager is responsible for enhancement to existing products and development of new products to broaden current service offerings. This role is also accountable for project management and implementation management with new and existing clients. The primary purpo...

The Correspondence Team Lead is responsible for monitoring and tracking all processes pertaining to the Correspondence Team. This role may assist the supervisor with additional projects/tasks. This is a remote position. Creates and maintains reports in worksheets and formulas in ...

The Appeals Team Lead assists injured workers, claims examiners, attorneys, providers, etc. in locating providers within the medical provider network (MPN), verifying provider inclusion in an MPN and scheduling appointments upon request for the injured worker. This position inclu...