Itemized Bill Review Auditor III

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

📋 Description

• Review medical records to confirm that services billed were actually provided for Hospital Bill Audit evaluations.

• Detect overcharges, undercharges, and unbundled items.

• Recognize unbundled items on itemized bills in accordance with payer unbundling guidelines, providing references and rationale for findings.

• Maintain prompt communication with the Audit Coordinator regarding the scheduling, completion, and submission of audits.

• Oversee audit inventory and coordinate audits by reaching out to providers to set dates and times.

• Arrange travel for onsite audits following EXL travel policy.

• Report any issues encountered during the audit process to the Manager for resolution.

• Execute all tasks in compliance with company policies on compliance, information security, and regulatory standards.

⛳️ Requirements

• A minimum of 5+ years of acute care clinical experience in medical/surgical units is required.

• Must be a Licensed Nurse with an active current license.

• At least 3+ years of experience in hospital bill auditing, focusing on high-dollar claims paid as a percentage of billed charges, whether on the payer or provider side.

• CPC, CCS, or CMAS certification is preferred.

• Proficiency in Excel is necessary.

• Familiarity with basic data entry tasks is required.

• Exceptional interpersonal and communication skills are essential.

• Ability to prioritize tasks and work independently is crucial.

• Knowledge of hospital bill auditing, payer-specific unbundling guidelines, industry standards, and Medicare regulations is important.

• Strong clinical background and technical skills are necessary.

• Flexibility for independent scheduling and potential travel to provider locations is expected.

• Compliance with HIPAA and other regulations regarding patient information confidentiality is mandatory.

🏝️ Benefits

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

• An exciting, fast-paced, and innovative work environment.

• Opportunity to collaborate closely with highly experienced healthcare consultants.

• Opportunities to gain insights into client business aspects, teamwork, and time-management skills.

• Further growth and development opportunities within EXL Health and beyond.

• Remote work opportunity from a U.S. home office.

• Travel may be required, ranging from 0–10%.