Clinical Bill Review Analyst

Valenz•Phoenix, AZ

2d•Remote

About The Position

As a Clinical Bill Review Analyst, you’ll review claims upfront and take a deeper dive to catch billing discrepancies, unbundled charges, and other errors based on standard billing practices and coding guidelines. You’ll help identify savings opportunities and share timely, actionable insights with internal teams and leadership to support the best outcomes for our clients. This role calls for strong communication, solid problem-solving skills, and a high level of attention to detail and organization.

Requirements

3+ years of auditing, claims, review and/or billing experience within a healthcare organization.
CPC and/or CIC certification
Working knowledge of industry coding, ICD-10, CPT, HCPCS Revenue codes etc.
Excellent communication skills, both verbal and written.
Knowledge of CMS guidelines

Nice To Haves

Experience in DRG validation.
Knowledge of Health Insurance, Medicare guidelines and various healthcare programs.
RevCycle Pro, Encoder Pro, and/or SuperCoder software experience.

Responsibilities

Review medical bills to identify appropriate billing, coding, and savings opportunities.
Analyze and resolve claim discrepancies that require a deeper level of expertise beyond initial review.
Collaborate with the Negotiation team to resolve more complex claim issues and secure additional savings.
Communicate findings to clients through detailed Bill Review Reports and assist in discussing complex bill-related inquiries.
Evaluate and respond to bill reconsideration requests, including those requiring additional research or analysis.
Handle escalated provider inquiries, resolve disputes, and conduct direct negotiations for billing discrepancies.
Provide guidance and mentor junior analysts in claim review best practices.
Assist in identifying trends in billing issues, proposing system/process improvements, and contributing to policy development.
Support training efforts by educating internal teams and clients on changes to codes, edits, and bill review procedures.
Work cross-functionally with internal teams to identify and implement process efficiencies that improve savings and client satisfaction.
Ensure compliance with HIPAA and other regulatory standards.
Perform other duties as assigned.
Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

Benefits

Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
Spending account options: HSA, FSA, and DCFSA
401K with company match and immediate vesting
Flexible working environment
Generous Paid Time Off to include vacation, sick leave, and paid holidays
Employee Assistance Program that includes professional counseling, referrals, and additional services
Paid maternity and paternity leave
Pet insurance
Employee discounts on phone plans, car rentals and computers
Community giveback opportunities, including paid time off for philanthropic endeavors