Itemized Bill Review Auditor III

This is a fully remote position, open to applicants in United States.

📋 Description

• Examine medical records to confirm that services billed were actually provided during Hospital Bill Audit reviews.

• Detect overcharges, undercharges, and unbundled items.

• Identify unbundled items on the itemized bill in accordance with payer Unbundling Guidelines, providing references and rationale to substantiate review findings.

• Onsite Travel – Ensure timely communication with the Audit Coordinator regarding the scheduling, completion, and submission of audits. Adhere to the EXL Travel policy while arranging travel for onsite audits.

• Scheduling Audits: Oversee inventory and promptly schedule audits by reaching out to the provider to arrange dates and times for conducting audits.

• Notify the Manager of any issues encountered during the audit process for resolution.

• Adhere to HIPAA and other regulations concerning the confidentiality of patient information.

• Execute all job functions and responsibilities in compliance with the company's Compliance, Information Security, and Regulatory policies, procedures, and programs.

⛳️ Requirements

• At least 5+ years of acute care clinical experience in medical/surgical units.

• Active and current nursing license.

• A minimum of 3+ years of experience in hospital bill auditing for high dollar claims paid at a percentage of billed charges, either from the payer or provider perspective.

• CPC, CCS, or CMAS certification is preferred.

• Proficient in Excel.

• Familiarity with basic data entry tasks.

• Strong interpersonal and communication skills.

• Ability to prioritize tasks and work independently.

🏝️ Benefits

• Competitive benefits package, including medical, dental, vision, and a 401(k) plan.