Remote Lead Itemized Bill Review Auditor

Gainwell Technologies LLC; Clifton (TX); A distancia; USD 60.000 - 86.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Generous vacation policy

Educational assistance

Leadership development academies

Descripción de la vacante

Gainwell Technologies is seeking a Lead Associate, Itemized Bill Review Quality Auditor to perform reviews of medical records, healthcare claims, itemized bills, and UB-04 forms to ensure accuracy and compliance. You will lead quality assurance audits and oversee itemized bill review activities, ensuring alignment with client methodologies and regulatory requirements.

The role requires extensive knowledge of hospital charging practices, CMS reimbursement, NCCI edits, and payment integrity

Formación

• Associate degree in Health Information Management, Nursing, Healthcare Administration, Business Administration, or related healthcare field required.
• Certified Coder or Registered Nurse with Coding Experience; RHIA, RHIT, CCS, CIC, CPMA, CCDS, COC or CPC preferred.
• Comprehensive knowledge of Revenue Codes, CPT, HCPCS, ICD-10 Coding Guidelines, UB-04/UB-O4 billing requirements.
• 5 years of healthcare billing, coding, payment integrity, revenue cycle, or itemized bill review experience required.

Responsabilidades

• Perform quality audits of itemized bill reviews to ensure accuracy, consistency, compliance and proper documentation.
• Validate audit findings by reviewing itemized bills, medical records, claims, contracts, fee schedules and supporting documentation.
• Evaluate billing errors, duplicate charges, unsupported services, coding, modifiers, units and payer requirements.
• Conduct complex audits of institutional claims, itemized bills and medical records to identify inaccuracies and billing issues.
• Review inpatient, outpatient, emergency, ambulatory surgery, and ancillary service charges for billing and reimbursement accuracy.
• Identify payment integrity opportunities through billing and reimbursement reviews.
• Serve as SME in proposals, assist with training and mentoring of new reviewers.
• Maintain current clinical and coding knowledge and cross-train across multiple claim types.

Descripción del empleo

Gainwell Technologies is seeking a Lead Associate, Itemized Bill Review Quality Auditor to perform reviews of medical records, healthcare claims, itemized bills, and UB-04 forms to ensure accuracy and compliance. You will lead quality assurance audits and oversee itemized bill review activities, ensuring alignment with client methodologies and regulatory requirements.

The role requires extensive knowledge of hospital charging practices, CMS reimbursement, NCCI edits, and payment integrity