Medical Itemized Bill Reviewer (IBRL-1 Analyst)

The Rawlings Group; Roseville (CA); Remote; USD 75,000 - 85,000; Full time

Job summary

An established industry player is seeking a detail-oriented Medical Itemized Bill Reviewer. In this fully remote role, you will analyze insurance claims, ensuring compliance with industry standards while maximizing financial outcomes for clients. This position offers a unique opportunity to contribute to a transformative healthcare intelligence company, where your expertise will drive efficiency and accuracy in claim reviews. Join a team that values integrity and innovation, and enjoy a comprehensive benefits package including health coverage, PTO, and tuition reimbursement. If you're ready to make a significant impact in the healthcare sector, this role is for you.

Benefits

PTO, Paid Holidays, and Volunteer Days

Health, Vision, and Dental Coverage

401(k) Plan Participation with Company Match

Tuition Reimbursement

Company-Paid Life Insurance

Short-Term Disability Benefits

Parental Leave

Remote Work Options

Qualifications

• 1+ years in itemized bill review required.
• 2+ years in healthcare billing and coding required.
• Experience in healthcare payment integrity industry required.

Responsibilities

• Review medical claims to ensure accuracy of charges.
• Validate system denials and enhance processing efficiency.
• Consult with Senior Analysts on claim reviews.

Skills

Attention to Detail

Analytical Skills

Communication Skills

Problem-Solving Skills

Education

Bachelor's Degree in Health Administration

Bachelor's Degree in Business

Bachelor's Degree in Nursing

Tools

Microsoft Office Suite

Windows Office Systems

Job description

Job Details

Experienced California Office - Roseville, CA Fully Remote Full Time Bachelor's Degree Level Job Location Remote Type Position Type Education Level

$75000.00 - $85000.00 Salary/year None Day Insurance Salary Range Travel Percentage Job Shift Job Category

Medical Itemized Bill Reviewer (IBRL-1 Analyst)

Who We Are

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Location: This role is full remote

About the Opportunity

At Machinify, we're constantly reimagining what's possible in our industry-creating disruptively simple, powerfully clear ways to maximize our clients' financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions team, you will, as an Medical Itemized Bill Reviewer (IBR Level 1 Analyst), be responsible for reviewing insurance claims to determine true and accurate charges. This role requires the analysis of the UB-04, the detailed itemized statement, and medical documentation when provided. The analyst will apply the client policy and industry standards when reviewing these claims. This role must identify billed items and services that do not meet the appropriate compliance guidelines. This role requires clinical expertise, as well as previous payment integrity experience.

What you'll do

• Perform an in-depth review of medical claims utilizing the UB-04 and detailed itemized statement to ensure the validity of line-item charges.


• Verify accuracy of the itemized charges to be reimbursed according to client policy and industry standards.


• Validate automatic system denials and create additions to enhance efficient processing of IBR claims.


• Recommend system enhancements and edits to improve claim review efficiency.


• Comply with company standards regarding accuracy and productivity to manage daily assignments and meet client turnaround times.


• Consult with Senior Analysts with any questions and/or issues related to claim reviews.


• Assist in content development, automation, research, and appeal responses as needed.


• Provide input and collaboration concerning content development with internal groups and on global projects as needed.


• Attend all required meetings.


• Assists in special projects and perform other duties as needed.

What experience you bring (Role Requirements)

• Bachelor's degree (health administration, business, nursing)


• Equivalent experience of 1+ years in itemized bill review


• Equivalent experience of 2+ years in healthcare billing and coding


• Experience and background in healthcare payment integrity industry required


• Possess significant attention to detail and excellent written and verbal skills


• Excellent organizational, analytical, and problem-solving skills


• Capable of handling multiple projects in a fast paced, hyper-growth environment


• Strong ability to work independently and work with internal teams communicating change across the business

Computer Equipment and Software:

• Experience working with multiple monitors


• Proven success in a remote working environment


• Proficient in Windows office systems, including the full Microsoft Suite and Teams


• Advanced skills in Microsoft Office (Excel, PowerPoint, Word)


• Experience with various software applications and collaboration with development teams

What Success Looks Like...

After 3 months

• You will have a strong understanding of the role.


• You begin building relationships and collaborating with peers.


• You develop effective time and priorities management.


• You receive initial feedback about your performance and are using it to improve.


• You've gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

• You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.


• You have established a strong network of internal relationships and are recognized as a key collaborator.


• You've been entrusted with greater responsibility indicating the company's confidence in your abilities.


• You see opportunities for career progression and personal development.

Pay range: $75,000-$85,000 USD

This is an exempt position. The salary range is for Base Salary.Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee's geographic location.

What's in it for you

• PTO, Paid Holidays, and Volunteer Days


• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts


• Tuition Reimbursement


• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.


• Remote and hybrid work options

At Machinify, we're reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative, accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we're passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer.

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