Medical Itemized Bill Review Specialist

Blue Signal; Rochester (MN); Remote; USD 80,000 - 100,000; Full time

Job summary

Join a high-growth startup dedicated to transforming U.S. healthcare as a Medical Itemized Bill Review Specialist. In this pivotal role, you will automate medical claim audits, ensuring accuracy in billing and compliance with national coding guidelines. Collaborate with a diverse team to drive innovation in healthcare while enjoying the flexibility of remote work. This opportunity offers a dynamic environment where your skills in medical billing and coding will make a significant impact. If you are passionate about leveraging technology to enhance healthcare, this role is perfect for you.

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.
• Extensive knowledge of national coding guidelines and compliance.

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 coding knowledge

HCPCS codes knowledge

DRGs and APCs knowledge

PHI/HIPAA compliance

Auditing experience

CPC/COC/CIC/CRC/CPMA certification

Clinical license (RN)

Education

Certification in coding (CPC/COC/CIC/CRC/CPMA)

Clinical license (RN)

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