Medical Itemized Bill Review Specialist

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