Responsible for analyzing high-dollar, complex claims using research, coding standards, industry knowledge, and federal regulations to ensure correct billing practices. This role performs detailed itemized bill reviews to identify billing abnormalities, unbundling, questionable billing practices, and improper coding combinations from both a clinical and coding perspective. The position also documents denial reasoning or erroneous activity and supports coding operations, education, and process improvement initiatives.
Requirements & Qualifications
- High school diploma required; bachelor's degree in a related field preferred.
- Minimum 5 years of experience in line-item bill review.
- Completion of educational curriculum required for a medical license or coding certification.
- Strong knowledge of inpatient and outpatient hospital billing, including UB-04s, revenue codes, itemized charges, CPT, HCPCS, ICD-10 diagnosis and procedure codes.
- Extensive knowledge of DRG/APCs.
- Understanding of payer reimbursement policies, state and federal regulations, medical necessity criteria, and industry standards.
- Auditing and health information management experience in a healthcare setting.
- Experience with professional and facility contract interpretation.
- Proficiency with Microsoft Office Suite, especially Excel, Outlook, and PowerPoint; Visio preferred.
- Strong written and verbal communication, analytical, organizational, problem-solving, and customer service skills.
- Ability to read and abstract medical records, interact with providers, and mentor or train others.
- Ability to work evening or weekend hours as needed and manage multiple tasks in a fast-paced environment.
- Knowledge of medical terminology, anatomy, and physiology.
Benefits & Perks
- Medical, dental, and vision coverage with low deductible and copay
- Life insurance
- Short- and long-term disability
- Paid parental leave
- 401(k) with match
- Employee stock purchase plan
- Generous paid time off
- 10 paid company holidays
- Tuition reimbursement
- Flexible spending account
- Employee assistance program
- Sick time benefits
- Bonus opportunity
- Flexible schedules when possible
- Professional development and educational programs
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Salary Range
$75,000 - $80,000
Remote work allowed
Yes
Posted
3 weeks ago
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