Clinical Bill Review Analyst (Healthcare)

TL;DR

Clinical Bill Review Analyst (Healthcare): Reviewing medical claims to identify billing discrepancies, unbundled charges, and savings opportunities with an accent on coding accuracy and regulatory compliance. Focus on resolving complex claim disputes, mentoring junior staff, and ensuring adherence to HIPAA standards.

Location: Must be US based

Company

hirify.global is a healthcare platform providing integrated solutions to simplify the patient journey, reduce costs, and improve payment integrity for employers and payers.

What you will do

• Review medical bills to identify appropriate billing, coding, and savings opportunities.
• Analyze and resolve complex claim discrepancies beyond initial review.
• Collaborate with the negotiation team to secure additional savings on complex issues.
• Communicate findings to clients through detailed reports and assist with inquiries.
• Handle escalated provider inquiries and conduct direct negotiations for billing disputes.
• Mentor junior analysts and contribute to process improvements and policy development.

Requirements

• 3+ years of auditing, claims, or billing experience within a healthcare organization.
• CPC and/or CIC certification.
• Working knowledge of industry coding, ICD-10, CPT, HCPCS, and Revenue codes.
• Must be US based and able to comply with HIPAA and company security protocols.
• Knowledge of CMS guidelines.
• Excellent verbal and written communication skills.

Nice to have

• Experience in DRG validation.
• Knowledge of Health Insurance, Medicare guidelines, and various healthcare programs.
• Experience with RevCycle Pro, Encoder Pro, or SuperCoder software.

Culture & Benefits

• Generously subsidized Medical, Dental, and Vision insurance.
• 401K with company match and immediate vesting.
• Spending account options including HSA, FSA, and DCFSA.
• Generous Paid Time Off including vacation, sick leave, and holidays.
• Paid maternity and paternity leave.
• Flexible working environment with provided equipment.