Medical Itemized Bill Reviewer

Clarishealth

5+ years

$55,000 to $65,000 per year

Nashville

10 Nov. 23, 2024

Job Description

Job Type: Full Time Education: GED/B.Sc./M.Sc./B.Pharm/M.Pharm/Life science Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Why Work Here?

At ClarisHealth, we embrace the #GYB (Got Your Back) mantra, offering outstanding benefits, a growing company culture where the sky’s the limit, and the opportunity for commission eligibility. We currently work remotely and prioritize work-life balance.

Position Title: Itemized Bill Reviewer

Location: Remote
Company: ClarisHealth

Job Summary

The Itemized Bill Reviewer role is designed for a professional with a robust understanding of facility-based coding practices, CMS billing rules, and state-specific reimbursement guidelines. This position is responsible for interpreting payer reimbursement policies, building and maintaining rule-based criteria, and performing audits to ensure billing accuracy. The ultimate goal is to drive high-quality recoverable dollars for our clients.

Responsibilities

Primary Duties

Review itemized inpatient acute care hospital bills to ensure coding accuracy and compliance with reimbursement policies.
Investigate and apply expertise in coding and billing practices within the claims adjudication process.
Maintain and update rule-based criteria for itemized bill reviews in response to CMS updates and client-specific requirements.
Identify and assign appropriate ICD-10-CM/PCS codes, ensuring compliance with CMS requirements, coding guidelines, and Coding Clinic standards.
Apply current CMS citation guidelines, including NCCI edits, MUE, PTP, and OPPS criteria.
Exhibit strong knowledge of anatomy, physiology, diagnostic procedures, and surgical operations to substantiate code assignments.
Write clear, concise rationales for findings and recommendations.
Provide expertise and support to investigative and analytical areas as needed.
Manage a high-volume caseload, prioritizing quality and accuracy.

Additional Duties

Participate in team meetings and assist with process improvements.
Adapt to other duties as assigned by the supervisor while maintaining professionalism.

Qualifications

Required Skills and Certifications

Education: High school diploma or GED equivalent (Higher education is a plus).
Experience:
- 5+ years of experience in inpatient acute care hospital itemized bill reviews, including high-cost outlier reimbursement and repricing.
- Expertise with ICD-10-CM and DRG coding.
Certifications:
- Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC).
- Certified Professional Coder (CPC).
Proficiency in CMS billing practices and coding guidelines.
Ability to analyze medical records and apply appropriate reimbursement methodologies.
Strong organizational skills to manage multiple projects and meet deadlines.
Positive, self-motivated attitude with a passion for problem-solving and team collaboration.

Why You’ll Love Working at ClarisHealth

ClarisHealth fosters a supportive, innovative culture grounded in creativity and collaboration. Our values include:

Compassionate: Practicing servant leadership, inclusion, and celebrating team contributions.
Communicators: Listening first, seeking solutions, and promoting radical candor with positive intent.
Challengers: Taking ownership, creating clarity from complexity, and delivering results with accountability.

Benefits

Flexible, remote-first working environment.
Health Insurance: Options include $0 premium HDHP and $0 deductible PPO.
Vision and dental coverage.
Company-paid benefits: Telemedicine, life insurance, and short-term disability (STD).
Voluntary long-term disability (LTD) and additional life insurance options.
First-day coverage for all benefits listed.
Generous Paid Time Off (PTO), including vacation, wellness days, floating holidays, and volunteer time off.
401(k) with immediate matching and vesting.

Company Overview

ClarisHealth, based in Nashville, TN, revolutionizes claims payment accuracy for health plans and payers through its proprietary AI-powered platform, Pareo®. Our technology helps reduce manual work, provide operational insights, and accelerate overpayment prevention strategies.

Additional Information

Applicants must be authorized to work in the U.S.
ClarisHealth cannot sponsor work visas at this time.
We are an equal opportunity employer (EOE) and provide accommodations for applicants needing assistance during the interview process.

To learn more about ClarisHealth and our mission, visit us at clarishealth.com/careers.

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