Clinical Bill Review Analyst

TL;DR

Clinical Bill Review Analyst (Healthcare): Review medical bills to identify billing discrepancies, unbundled charges, and savings opportunities with an accent on standard billing practices and coding guidelines. Focus on analyzing complex claims, resolving disputes through negotiation, and mentoring junior analysts on best practices.

Location: Fully remote, must be US based to comply with company policies such as HIPAA.

Company

Platform simplifying healthcare for employers, payers, providers, and members to reduce costs, improve quality, and elevate the experience.

What you will do

• Review medical bills for appropriate billing, coding, and savings opportunities.
• Analyze and resolve complex claim discrepancies requiring deeper expertise.
• Collaborate with negotiation team to secure additional savings on complex issues.
• Communicate findings via detailed reports and handle client inquiries.
• Evaluate bill reconsideration requests and escalated provider disputes.
• Mentor juniors, identify billing trends, and contribute to process improvements and training.

Requirements

• 3+ years of auditing, claims review, and/or billing experience in healthcare.
• CPC and/or CIC certification.
• Working knowledge of ICD-10, CPT, HCPCS, revenue codes, and CMS guidelines.
• Excellent verbal and written communication skills.
• Compliance with HIPAA and regulatory standards.
• US based location with quiet workspace, reliable internet, and adherence to security protocols including VPN.

Nice to have

• Experience in DRG validation.
• Knowledge of health insurance, Medicare guidelines, and healthcare programs.
• RevCycle Pro, Encoder Pro, or SuperCoder software experience.

Culture & Benefits

• Generously subsidized medical, dental, vision insurance, HSA, FSA, DCFSA.
• 401K with company match and immediate vesting.
• Generous PTO including vacation, sick leave, holidays, maternity/paternity leave.
• Flexible remote work environment with provided equipment.
• Employee Assistance Program, pet insurance, discounts, and community giveback opportunities.