Itemized Bill Reviewer

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

📋 Description

• Implement internal solutions for payment integrity that necessitate expertise in billing and coding.

• Conduct thorough reviews of high-value facility itemized bills alongside related claim forms, examining each line meticulously.

• Detect and document billing discrepancies, duplicate charges, improper unbundling, and charges for services that are either not covered or not rendered.

• Compare billed amounts against payor-specific contracts and standard industry guidelines.

• Utilize national coding systems to verify service codes.

• Analyze claims within particular reimbursement scenarios and stop-loss limits.

• Record findings, cost savings, policy breaches, and suggested claim modifications.

• Enhance internal auditing processes and tools.

• Act as a subject matter expert on billing challenges, coding standards, and payor regulations.

• Identify payment discrepancies through data analysis and process oversight, and outline corrective measures.

• Address inquiries and disputes regarding policies and edits.

• Document coding standards and propose language and scope for reimbursement policies.

• Transform payment integrity opportunities into business requirements while collaborating with internal stakeholders.

• Provide training and education to team members.

• Keep stakeholders updated on progress, obstacles, and changes in status.

• Assist with escalated issues through in-depth research and root cause analysis.

• Adhere to relevant laws and regulations.

• Perform additional duties as assigned.

⛳️ Requirements

• A bachelor’s degree or 4+ years of equivalent experience.

• At least 2 years of experience in auditing bills/coding with an emphasis on hospital or facility billing (UB-04).

• Minimum of 4 years of experience in medical coding.

• Medical coding certification from AAPC (CPC, COC) or AHIMA (CCS, RHIT, RHIA).

• Familiarity with reimbursement methodologies, concepts of provider contracts, and standard claims processing/resolution practices.

• Bonus: Over 3 years of experience handling large datasets using Excel or a database language.

• Bonus: Experience in knowledge management, training, or content development within operational environments.

• Bonus: Training in Process Improvement or Lean Six Sigma.

• Bonus: Proficiency in SQL.

🏝️ Benefits

• Comprehensive employee benefits.

• Unlimited vacation program.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick leave.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life insurance coverage.

• Disability insurance.

• Paid wellness time and reimbursements.

• Occasional travel for team meetings and company events.