Clinical Bill Review Analyst

Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible. About This Opportunity: As a Clinical Bill Review Analyst, you’ll review claims upfront and take a deeper dive to catch billing discrepancies, unbundled charges, and other errors based on standard billing practices and coding guidelines. You’ll help identify savings opportunities and share timely, actionable insights with internal teams and leadership to support the best outcomes for our clients. This role calls for strong communication, solid problem-solving skills, and a high level of attention to detail and organization. Things You’ll Do Here: Review medical bills to identify appropriate billing, coding, and savings opportunitiesAnalyze and resolve claim discrepancies that require a deeper level of expertise beyond initial reviewCollaborate with the Negotiation team to resolve more complex claim issues and secure additional savingsCommunicate findings to clients through detailed Bill Review Reports and assist in discussing complex bill-related inquiriesEvaluate and respond to bill reconsideration requests, including those requiring additional research or analysisHandle escalated provider inquiries, resolve disputes, and conduct direct negotiations for billing discrepanciesProvide guidance and mentor junior analysts in claim review best practicesAssist in identifying trends in billing issues, proposing system/process improvements, and contributing to policy developmentSupport training efforts by educating internal teams and clients on changes to codes, edits, and bill review proceduresWork cross-functionally with internal teams to identify and implement process efficiencies that improve savings and client satisfactionEnsure compliance with HIPAA and other regulatory standardsPerform other duties as assigned Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties. What You’ll Bring to the Team: 3+ years of auditing, claims, review and/or billing experience within a healthcare organizationCPC and/or CIC certification Working knowledge of industry coding, ICD-10, CPT, HCPCS Revenue codes etcExcellent communication skills, both verbal and writtenKnowledge of CMS guidelines A plus if you have: Experience in DRG validationKnowledge of Health Insurance, Medicare guidelines and various healthcare programsRevCycle Pro, Encoder Pro, and/or SuperCoder software experience Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment! Work Environment: You’ll need a quiet workspace that is free from distractionsTechnology: Reliable internet connection—if you can use streaming services, you’re good to go!Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/softwareLocation: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA Why You'll Love Working Here Valenz is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do. Benefits Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx CardSpending account options: HSA, FSA, and DCFSA401K with company match and immediate vestingFlexible working environmentGenerous Paid Time Off to include vacation, sick leave, and paid holidaysEmployee Assistance Program that includes professional counseling, referrals, and additional servicesPaid maternity and paternity leavePet insuranceEmployee discounts on phone plans, car rentals and computersCommunity giveback opportunities, including paid time off for philanthropic endeavors At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics. Powered by JazzHR SE3pKqzLuu