Medical Itemized Bill Review Specialist
Our client is a high-growth, venture-backed startup, dedicated to revolutionizing the U.S. healthcare system. They encourage collaboration among individuals with diverse backgrounds and ideologies to drive innovation. If you're passionate about leveraging cutting-edge technologies to make a significant impact on U.S. healthcare, we invite you to join this company’s mission-driven team.
As a Medical Itemized Bill Review Specialist, you will play a crucial role in automating medical claim audits. You will review claim forms, patient medical records, and audit results to train their platform. The primary responsibilities include identifying coding/billing violations, auditing revenue codes against clinical documentation, and ensuring accuracy in claims billed versus health plan payments.
This Role Offers:
- Medical, Dental, and Vision benefits
- Flexible, paid vacation policy
- Work in a flat organizational structure with direct access to leadership.
Focus:
- Review UB-04/IB forms for coding/billing violations.
- Audit revenue codes against clinical documentation.
- Confirm services billed were rendered.
- Document inconsistencies in claims versus health plan payments.
- Validate automatic audit results based on national and payer-specific guidelines.
Skill Set:
- Facility inpatient coding/auditing experience is required.
- Extensive experience in medical billing, coding, or auditing of insurance claims and medical records.
- Familiarity with national coding guidelines such as CPT codes, ICD-9/10, HCPCS codes, DRGs, APCs, etc.
- Knowledge of hospital-based billing/coding and PHI/HIPAA compliance.
- At least three years of experience in auditing and reviewing medical bills.
- One of the following certifications is mandatory: CPC/COC/CIC/CRC/CPMA.
- Clinical license preferred (RN).
- Experience working at an insurance company is preferred.
- 100% remote work considered for the right candidate.
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