[Hiring] Medical Bill Reviewer @Alaffia Health

Role Description

We are looking for a Medical Bill reviewer to join our team! Do you have experience reviewing claim forms and auditing provider documentation? Then this position is for you! You will work alongside our team to empower our clients with technology that will modernize medical claim auditing.

You will be responsible for reviewing and analyzing medical claims, patient medical records, and automatic claim audit results to help train our machines to deliver automated audit results. You will be performing high-dollar facility bill reviews. Your role will be integral to your engineering teams and will help inform decisions that will shape the future of healthcare we aim to see.

Your Responsibilities

• Combing through UB-04/IB's for any potential coding/billing violations
• Comparing the IB/UB-04 against the medical record to validate charges and assess the quality of the medical record
• Auditing revenue codes against clinical documentation
• Confirmation of services billed were rendered
• Clear documentation of inconsistencies with claims billed vs health plan payments
• Confirming automatic audit results based on national and payer-specific guidelines

Qualifications

• Facility Inpatient Coding/Auditing Experience (Required)
• At least one of the following certifications is mandatory (CPC/CIC/CRC/CPMA)
• Clinical license (RN) required
• Experience working at an insurance company (preferred)
• Experience performing audits on line item charges on Itemized Bills
• Deep background in medical billing, coding, or auditing of insurance claims and medical records
• Experience working with national guidelines such as CPT codes, ICD-9/10, HCPCS codes, POS codes, DRGs, APCs, and other code sets and the translation of written clinical information into auditable clinical content
• Knowledge of hospital-based billing/coding
• Knowledge of PHI/HIPAA compliance and standards
• Ability to research and verify claim coding accuracy
• Minimum of 3 years of auditing/bill review experience

Benefits

• Competitive compensation package
• Medical, Dental and Vision benefits
• Flexible, paid vacation policy
• Work in a flat organizational structure — direct access to Leadership