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    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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