Bill Review Specialist

WellRithms, Inc.; Portland (OR); On-site; USD 50,000 - 65,000; Full time

Job summary

WellRithms, Inc. is seeking a Bill Review Specialist in Portland, Oregon, to analyze medical bills and apply reimbursement methodologies accurately. This position requires expertise in medical billing and CPT coding along with strong communication skills. You will focus on resolving billing discrepancies and maintaining compliance with regulations.

The ideal candidate will have a high school diploma, with 2-3 years of relevant experience preferred, and should be comfortable with MS Office software. If you're system-oriented and detail-focused, we want to hear from you!

Qualifications

• 2-3 years of experience in healthcare or related field preferred.
• Knowledge of CPT coding and medical terminology required.
• Familiarity with HCFA1500 and UB-04 billing forms.

Responsibilities

• Analyze medical bills applying reimbursement methodology.
• Perform comprehensive reviews of medical bills and documentation.
• Prepare clear reimbursement determinations based on evaluations.

Skills

Medical billing expertise

CPT coding knowledge

Excellent communication skills

Attention to detail

Education

High School diploma

Some college

CPC certification

Tools

MS Word

MS Excel

MS Outlook

Job description

Overview

As a Bill Review Specialist, you are responsible for applying WellRithms’ reimbursement methodology through medical bill review. This role calls for expertise in medical billing and CPT coding, as well as the ability to process medical bills accurately and efficiently. Experience in group health or workers’ compensation is a strong plus. You will develop a deep understanding of client workflows, reimbursement methodologies, regulatory requirements, and provider billing practices while serving as a key contributor to the accurate and consistent resolution of medical billing reviews and reconsideration requests. This position reports to the Bill Review Supervisor.

Responsibilities

• Analyze medical bills and apply the WellRithms reimbursement methodology accurately and consistently.
• Perform a comprehensive review of medical bills, medical records, itemized statements, and supporting documentation to determine reasonable reimbursement.
• Review, process, and validate the correct use of CPT codes and other applicable medical billing standards.
• Investigate billing discrepancies, reimbursement disputes, and reconsideration requests by evaluating claim documentation and supporting evidence, and prepare clear, well-supported reimbursement determinations.
• Identify and correct billing, coding, or documentation errors while working within established workflows to complete medical reviews.
• Communicate with medical providers and other stakeholders to obtain additional information and facilitate claim resolution.
• Stay informed of industry trends, reimbursement guidelines, fee schedules, and regulatory changes impacting medical bill review and reimbursement practices.
• Meet established productivity and quality assurance expectations while managing a high-volume workload. Perform other duties as assigned.

Qualifications

• High School diploma is required; some college is preferred.
• 2-3 years of experience in healthcare or a related field is preferred.
• Knowledge of CPT coding and medical terminology.
• Familiarity with HCFA1500 and UB-04 billing forms.
• Excellent written and oral communication skills.
• Ability to meet deadlines in a time-sensitive environment.
• High comfort level with computers and software programs (MS Word, Excel, Outlook).
• CPC (Certified Professional Coding) education or certification is preferred.