Itemized Bill Review Associate
Core
Review high-dollar facility itemized bills and claim forms to ensure accurate and timely payments by identifying billing errors, coding inaccuracies, and contract violations.
Role type
Senior IC medical billing and coding auditor
Builds
Payment integrity solutions and internal audit processes
Domain
Health insurance / Medical billing and coding
Required skills
UB-04 billing review, CPT/HCPCS/ICD-10/MS-DRGs coding, payor contract analysis, reimbursement methodologies, claims processing, data mining, root cause analysis, policy documentation, training delivery
Preferred skills
SQL, large dataset analysis, Lean Six Sigma, knowledge management
Technologies
UB-04, CPT, HCPCS, ICD-10, MS-DRGs, Excel, SQL
Responsibilities
Perform line-by-line review of high-dollar facility itemized bills and corresponding claim forms; Proactively identify and document potential billing errors including duplicate billing, unbundling, and non-covered services; Compare billed charges against payor-specific contracts and industry guidelines; Apply working knowledge of national coding systems to validate accuracy; Prepare clear documentation of findings including savings and policy violations; Contribute to refinement of internal audit processes and tools; Serve as subject matter expert for complex billing issues; Identify claims payment issues from data mining and process monitoring; Document industry standard coding rules and provide recommendations on reimbursement policy; Ideate payment integrity opportunities and translate into business requirements; Provide training and education to team members.
Seniority
Mid-Senior level, hands-on IC