Job Description
Job Summary:
We are seeking a detail-oriented Itemized Bill Reviewer who has a strong background in facility-based coding practices and a deep understanding of CMS billing rules and state-specific reimbursement guidelines. In this role, you will interpret payer reimbursement policies and establish rules to ensure accurate billing on inpatient itemized bills. Your expertise will be crucial in maintaining the integrity of billing practices and conducting audits that drive high-quality recoverable dollars for our clients.
You Might Be a Great Fit If You Have:
A High School Diploma / GED (or higher)
5+ years of experience in inpatient acute care hospital itemized bill reviews, including high-cost outlier reimbursement and repricing of allowed charges
CCS or CIC certification
CPC certification
Proficiency in ICD-10-CM and DRG coding
A positive, self-motivated attitude and a drive for success
A team-oriented mindset with a knack for knowledge sharing
A high standard of personal integrity and accountability
A passion for solving complex problems
A fun attitude and a great sense of humor!
Benefits:
A remote-first, flexible working environment
Health insurance options, including $0 premium HDHP and $0 deductible PPO plans
Vision and dental coverage
Company-paid telemedicine services
Company-paid life insurance and short-term disability (STD) coverage
Voluntary long-term disability (LTD) and life insurance options
FIRST-DAY COVERAGE for all benefits listed above
401(k) plan with matching and immediate vesting
Generous paid time off, including vacation, wellness days, floating holidays, and volunteer time off
Responsibilities:
Investigate, review, and provide coding expertise related to billing practices and reimbursement policies throughout the claims adjudication process, ensuring thorough documentation review.
Conduct high-quality reviews to maintain the accuracy of medical coding and billing practices on itemized bills.
Generate and update rule-based criteria for itemized bill reviews as annual updates occur and client-specific requirements are clarified.
Identify ICD-10-CM/PCS code assignments, code sequencing, and discharge dispositions in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance.
Apply current CMS guidelines (NCCI edits, MUE, PTP, OPPS, etc.) and demonstrate knowledge of clinical criteria documentation requirements to support accurate code assignments.
Maintain a solid understanding of anatomy, physiology, diagnostic procedures, and surgical operations.
Write clear, accurate, and concise rationales to support your findings.
Manage daily case review assignments with a strong emphasis on quality.
Provide support and expertise to other investigative and analytical areas.
Thrive in a high-volume production environment.
Other Duties:
This job description is not intended to be exhaustive and may be subject to change as needed. You may be required to follow other instructions and perform additional duties as assigned by your supervisor. All team members are expected to maintain a professional work environment.
Employment Type: Full-Time
Salary: $ 55,000.00 65,000.00 Per Year
Job Tags
Holiday work, Full time, Temporary work, Immediate start, Flexible hours,