Medical Itemized Bill Review Specialist

Blue Signal; Nashville-Davidson (TN); Remote; USD 60,000 - 100,000; Full time

Job summary

Join a mission-driven startup dedicated to transforming the U.S. healthcare system as a Medical Itemized Bill Review Specialist. In this pivotal role, you'll automate medical claim audits, ensuring accuracy in billing and compliance with national guidelines. Collaborate with a diverse team and leverage your expertise in medical coding and auditing to make a meaningful impact. This innovative company promotes a flat organizational structure, providing direct access to leadership and fostering an environment where your contributions are valued. If you're passionate about enhancing healthcare through technology, this position offers the perfect opportunity to thrive.

Benefits

Medical benefits

Dental benefits

Vision benefits

Flexible paid vacation policy

Direct access to leadership

Qualifications

• 3+ years of experience in auditing and reviewing medical bills.
• Mandatory certification in CPC/COC/CIC/CRC/CPMA.

Responsibilities

• Review UB-04/IB forms for coding/billing violations.
• Audit revenue codes against clinical documentation.
• Document inconsistencies in claims versus health plan payments.

Skills

Facility inpatient coding/auditing experience

Medical billing and coding

CPT codes knowledge

ICD-9/10 familiarity

HCPCS codes knowledge

DRGs and APCs understanding

PHI/HIPAA compliance knowledge

Auditing medical bills

CPC/COC/CIC/CRC/CPMA certification

Clinical license (RN)

Education

High school diploma

Relevant certifications

Clinical license (preferred)

Job description

Medical Itemized Bill Review Specialist

Our client is a high-growth, venture-backed startup, dedicated to revolutionizing the U.S. healthcare system. They encourage collaboration among individuals with diverse backgrounds and ideologies to drive innovation. If you're passionate about leveraging cutting-edge technologies to make a significant impact on U.S. healthcare, we invite you to join this company’s mission-driven team.

As a Medical Itemized Bill Review Specialist, you will play a crucial role in automating medical claim audits. You will review claim forms, patient medical records, and audit results to train their platform. The primary responsibilities include identifying coding/billing violations, auditing revenue codes against clinical documentation, and ensuring accuracy in claims billed versus health plan payments.

This Role Offers:

• Medical, Dental, and Vision benefits
• Flexible, paid vacation policy
• Work in a flat organizational structure with direct access to leadership.

Focus:

• Review UB-04/IB forms for coding/billing violations.
• Audit revenue codes against clinical documentation.
• Confirm services billed were rendered.
• Document inconsistencies in claims versus health plan payments.
• Validate automatic audit results based on national and payer-specific guidelines.

Skill Set:

• Facility inpatient coding/auditing experience is required.
• Extensive experience in medical billing, coding, or auditing of insurance claims and medical records.
• Familiarity with national coding guidelines such as CPT codes, ICD-9/10, HCPCS codes, DRGs, APCs, etc.
• Knowledge of hospital-based billing/coding and PHI/HIPAA compliance
• At least three years of experience in auditing and reviewing medical bills.
• One of the following certifications is mandatory: CPC/COC/CIC/CRC/CPMA
• Clinical license preferred (RN)
• Experience working at an insurance company is preferred.
• 100% remote work considered for the right candidate

About Blue Signal:

Blue Signal is a leading executive search firm specializing in healthcare recruiting. Our healthcare recruiters have expertise in placing high-performing talent in healthcare IT, medical devices, biotechnology, pharmaceuticals, etc. Learn more at bit.ly/3G5DbWr