Itemized Bill Review Auditor III (IBR)

EXL•United States,

6d•$70,000 - $90,000

About The Position

The Itemized Bill Review Auditor conducts hospital charge audits on claims paid at a percentage of billed charges to verify that charges are appropriate and supported by medical-record documentation. The role identifies overcharges, undercharges, and unbundled items in accordance with carrier contracts, payer reimbursement policies, industry standards, and Medicare guidelines. The auditor needs hospital bill audit knowledge, including payer-specific unbundling guidelines, strong clinical experience, and technical skills. The position involves independently scheduling audits, managing audit inventory, contacting providers to arrange onsite reviews, and potentially traveling to provider locations. The auditor communicates with the Audit Coordinator about scheduling and audit completion and submission, reports process problems to the Manager, and follows company travel policies. The role also requires compliance with HIPAA and company compliance, information security, and regulatory policies. The stated salary range is $70,000–$90,000. The posting notes that final compensation depends on factors such as skills and experience, internal pay equity, location, and market conditions. The role may require 0–10% travel.

Requirements

At least 5 years of acute-care clinical experience in medical/surgical units.
Current active nurse license.
At least 3 years of hospital bill auditing experience on high-dollar claims paid at a percentage of billed charges, on the payer or provider side.
Excel proficiency.
Familiarity with basic data-entry tasks.
Excellent interpersonal and communication skills.
Ability to prioritize tasks and work independently.

Nice To Haves

CPC, CCS, or CMAS certification is desired.

Responsibilities

Review medical records to verify that services were provided as billed during hospital bill audits.
Identify overcharges, undercharges, and unbundled items.
Identify unbundled items on itemized bills according to payer unbundling guidelines and provide references and rationale for review findings.
Maintain timely communication with the Audit Coordinator about scheduling, completion, and submission of audits.
Follow the EXL travel policy when arranging travel for onsite audits.
Manage audit inventory and schedule audits promptly by contacting providers to arrange dates and times.
Report problems in the audit process to the Manager for resolution.
Comply with HIPAA and other regulations concerning patient-information confidentiality.
Perform job functions in accordance with company compliance, information security, and regulatory policies, procedures, and programs.