Remote Certified Medical Claims Auditor (CPC/CIC)

Vālenz Health®; Phoenix (AZ); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Generously subsidized Medical, Dental,

Vision insurance

HSA, FSA, and DCFSA

401K with company match

Flexible working environment

Paid time off

Employee Assistance Program

Maternity/Paternity leave

Pet insurance

Employee discounts

Job summary

Valenz Health is seeking a Clinical Bill Review Analyst for a fully remote role based in the United States. You will review medical bills, identify billing and coding opportunities, and support saving initiatives for clients with strong attention to detail and collaboration across teams.

Requirements include CPC and/or CIC certification, 3+ years of healthcare billing/auditing experience, knowledge of ICD-10/CPT/HCPCS, and CMS guidelines. Excellent communication is essential.

Qualifications

• 3+ years of auditing, claims, review and/or billing experience within a healthcare organization.
• CPC and/or CIC certification.
• Working knowledge of industry coding, ICD-10, CPT, HCPCS Revenue codes etc.
• Excellent communication skills, both verbal and written.
• Knowledge of CMS guidelines.

Responsibilities

• Review medical bills to identify appropriate billing, coding, and savings opportunities.
• Analyze and resolve claim discrepancies that require a deeper level of expertise beyond initial review.
• Collaborate with the Negotiation team to resolve more complex claim issues and secure additional savings.
• Communicate findings to clients through detailed Bill Review Reports and assist in discussing complex bill-related inquiries.
• Evaluate and respond to bill reconsideration requests, including those requiring additional research or analysis.
• Handle escalated provider inquiries, resolve disputes, and conduct direct negotiations for billing discrepancies.
• Provide guidance and mentor junior analysts in claim review best practices.
• Assist in identifying trends in billing issues, proposing system/process improvements, and contributing to policy development.
• Support training efforts by educating internal teams and clients on changes to codes, edits, and bill review procedures.
• Work cross-functionally with internal teams to identify and implement process efficiencies that improve savings and client satisfaction.
• Ensure compliance with HIPAA and other regulatory standards.
• Perform other duties as assigned.

Skills

CPC certification

CIC certification

Billing knowledge

Auditing experience

Tools

RevCycle Pro

Encoder Pro

SuperCoder

Job description

Valenz Health is seeking a Clinical Bill Review Analyst for a fully remote role based in the United States. You will review medical bills, identify billing and coding opportunities, and support saving initiatives for clients with strong attention to detail and collaboration across teams.

Requirements include CPC and/or CIC certification, 3+ years of healthcare billing/auditing experience, knowledge of ICD-10/CPT/HCPCS, and CMS guidelines. Excellent communication is essential.