Clinical Itemized Bill Reviewer (RN, CPC)

About the role

We are looking for a Medical Bill reviewer to join our team. This position requires current authorization to work in the United States. You will comb through UB-04/IB's for potential coding/billing violations, compare the IB/UB-04 against the medical record to validate charges and assess the quality of the medical record, audit revenue codes against clinical documentation, confirm services billed were rendered, clear documentation of inconsistencies with claims billed vs health plan payments, and confirm automatic audit results based on national and payer-specific guidelines.

Responsibilities

• Combing through UB-04/IB's for any potential coding/billing violations
• Comparing the IB/UB-04 against the medical record to validate charges and assess the quality of the medical record
• Auditing revenue codes against clinical documentation
• Confirmation of services billed were rendered
• Clear documentation of inconsistencies with claims billed vs health plan payments
• Confirming automatic audit results based on national and payer-specific guidelines

Requirements

• Facility Inpatient Coding/Auditing Experience
• At least one of the following certifications is mandatory (CPC/CIC/CRC/CPMA), or willingness to obtain within one year
• Clinical license (RN) required
• Experience working at an insurance company (preferred)
• Experience performing audits on line item charges on Itemized Bills
• Deep background in medical billing, coding, or auditing of insurance claims and medical records
• Experience working with national guidelines such as CPT codes, ICD-9/10, HCPCS codes, POS codes, DRGs, APCs, and other code sets and the translation of written clinical information into auditable clinical content
• Knowledge of hospital-based billing/coding
• Knowledge of PHI/HIPAA compliance and standards
• Ability to research and verify claim coding accuracy
• Minimum of 3 years of auditing/bill review experience

Qualifications

Competitive compensation package
Medical, Dental and Vision benefits
Flexible, paid vacation policy
Work in a flat organizational structure — direct access to Leadership

Benefits

Competitive compensation package
Medical, Dental and Vision benefits
Flexible, paid vacation policy
Work in a flat organizational structure — direct access to Leadership

Schedule

Remote

Pay

USD 80,000-90,000 / year