Itemized Bill Review Quality Auditor, Lead Associate

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

📋 Description

• Conduct quality audits of itemized bill evaluations.

• Confirm audit results by reviewing itemized bills, medical documentation, claims, contracts, fee schedules, and relevant supporting materials.

• Analyze billing discrepancies, duplicate charges, unsupported services, coding, modifiers, units, reimbursement methods, and compliance standards.

• Execute complex audits of institutional claims, itemized bills, and medical records.

• Review charges for inpatient, outpatient, emergency, ambulatory surgery, and ancillary services.

• Evaluate revenue codes, charge capture practices, HCPCS, CPT, ICD-10 support, and payer stipulations.

• Detect payment integrity opportunities.

• Act as a subject matter expert for business proposals.

• Assist in training, mentoring, and educating new reviewers.

• Keep abreast of current clinical and coding knowledge while cross-training across various claim types.

• Support client requirements alongside departmental quality and performance objectives.

⛳️ Requirements

• An Associate degree in Health Information Management, Nursing, Healthcare Administration, Business Administration, or a related healthcare discipline is mandatory.

• Certification as a Coder or Registered Nurse with Coding Experience is required.

• Preferred coding certifications include RHIA, RHIT, CCS, CIC, CPMA, CCDS, COC, or CPC.

• In-depth understanding of Revenue Codes, CPT, HCPCS, ICD-10 Coding Guidelines, Charge Master structure, UB-04 billing prerequisites, APC, ASC, OPPS, and DRG reimbursement methodologies.

• Advanced knowledge of hospital billing practices, itemized bill review techniques, and payment integrity principles.

• Capability to interpret and apply payer contracts, billing regulations, and reimbursement policies.

• A minimum of 3 years of Itemized Bill Review or Hospital Bill Audit experience is required.

• At least 3 years of outpatient auditing experience with expert knowledge of ICD-10 Official Coding.

• Preference for candidates with 3+ years of medical record review experience or claims auditing experience.

• A total of 5 years of experience in healthcare billing, coding, payment integrity, revenue cycle, or itemized bill review is required.

• Experience in auditing high-dollar institutional claims.

• Required experience in auditing hospital itemized bills and institutional claims.

• Extensive experience in reviewing hospital inpatient and outpatient billing practices.

• Must have a work location within the continental United States.

• A high-speed internet connection and a distraction-free work environment are essential.

• Must be available to work during standard business hours.

• May be required to work extended hours for specific business needs.

• Willingness to travel at least 10% of the time may be necessary.

🏝️ Benefits

• Flexible working hours.

• Balance between work and personal life.

• Opportunities for continuous learning and career advancement.

• Flexibility in work arrangements.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational support.

• Leadership and technical development academies.

• Potential for bonuses, stock options, profit sharing, life insurance, holiday pay, allowances, hotel accommodations, and reimbursement for travel expenses as part of the compensation package.