Clinical Bill Review Analyst

About the role

This opportunity is for a Clinical Bill Review Analyst who will review medical bills to identify appropriate billing, coding, and savings opportunities. They will analyze and resolve claim discrepancies, collaborate with the Negotiation team, communicate findings, and assist in identifying trends and process improvements.

Responsibilities

• Review medical bills to identify appropriate billing, coding, and savings opportunities
• Analyze and resolve claim discrepancies that require a deeper level of expertise beyond initial review
• Collaborate with the Negotiation team to resolve more complex claim issues and secure additional savings
• Communicate findings to clients through detailed Bill Review Reports and assist in discussing complex bill-related inquiries
• Evaluate and respond to bill reconsideration requests, including those requiring additional research or analysis
• Handle escalated provider inquiries, resolve disputes, and conduct direct negotiations for billing discrepancies
• Provide guidance and mentor junior analysts in claim review best practices
• Aid in identifying trends in billing issues, proposing system/process improvements, and contributing to policy development
• Support training efforts by educating internal teams and clients on changes to codes, edits, and bill review procedures
• Work cross-functionally with internal teams to identify and implement process efficiencies that improve savings and client satisfaction
• Ensure compliance with HIPAA and other regulatory standards

Requirements

• 3+ years of auditing, claims, review and/or billing experience within a healthcare organization
• CPC and/or CIC certification
• Excellent communication skills, both verbal and written
• Working knowledge of industry coding, ICD-10, CPT, HCPCS Revenue codes etc.

Qualifications

• Knowledge of CMS guidelines
• A plus if you have: Experience in DRG validation, Knowledge of Health Insurance, Medicare guidelines and various healthcare programs, RevCycle Pro, Encoder Pro, and/or SuperCoder software experience

Skills

• Strong communication, solid problem-solving skills, and a high level of attention to detail and organization

Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting
• Flexible working environment
• Generous Paid Time Off to include vacation, sick leave, and paid holidays
• Employee Assistance Program that includes professional counseling, referrals, and additional services
• Paid maternity and paternity leave
• Pet insurance
• Employee discounts on phone plans, car rentals and computers
• Community giveback opportunities, including paid time off for philanthropic endeavors

Pay

Compensation is commensurate with experience.

Schedule

The role is fully remote.

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 distractions

Technology

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/software

Location

You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA