Medical Itemized Bill Review Specialist

Blue SignalRochester, MN

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Medical Itemized Bill Review Specialist

Our client is a high-growth, venture-backed startup, dedicated to revolutionizing the U.S. healthcare system. They encourage collaboration among individuals with diverse backgrounds and ideologies to drive innovation. If you’re passionate about leveraging cutting-edge technologies to make a significant impact on U.S. healthcare, we invite you to join this company’s mission-driven team.

As a Medical Itemized Bill Review Specialist, you will play a crucial role in automating medical claim audits. You will review claim forms, patient medical records, and audit results to train their platform. The primary responsibilities include identifying coding / billing violations, auditing revenue codes against clinical documentation, and ensuring accuracy in claims billed versus health plan payments.

This Role Offers :

Medical, Dental, and Vision benefits
Flexible, paid vacation policy
Work in a flat organizational structure with direct access to leadership.

Focus :

Review UB-04 / IB forms for coding / billing violations.

Audit revenue codes against clinical documentation.

Confirm services billed were rendered.

Document inconsistencies in claims versus health plan payments.

Validate automatic audit results based on national and payer-specific guidelines.

Skill Set :

Facility inpatient coding / auditing experience is required.

Extensive experience in medical billing, coding, or auditing of insurance claims and medical records.

Familiarity with national coding guidelines such as CPT codes, ICD-9 / 10, HCPCS codes, DRGs, APCs, etc.

Knowledge of hospital-based billing / coding and PHI / HIPAA compliance

At least three years of experience in auditing and reviewing medical bills.

One of the following certifications is mandatory : CPC / COC / CIC / CRC / CPMA

Clinical license preferred (RN)

Experience working at an insurance company is preferred.

100% remote work considered for the right candidate

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Review Specialist • Rochester, MN