Clinical Bill Reviewer (RN License)

Job Summary

To support a growing Appeals and Disputes team, the full-time Clinical Bill Reviewer (RN License) will review and investigate provider disputes related to Payment Integrity findings, focusing on high-dollar facility claims and itemized bills in a remote work environment.

Key responsibilities

• Review and investigate provider disputes related to Payment Integrity audit findings
• Analyze itemized bills, UB-04 claim forms, medical records, and clinical documentation to assess billing accuracy
• Develop clear, well-supported written responses to provider disputes while managing a high-volume case queue

Required qualifications

• 3+ years of experience in Payment Integrity, medical bill review, or claims auditing
• Hands-on experience with itemized bill reviews and high-dollar facility claims
• Deep knowledge of medical billing, coding, and clinical documentation
• Active RN license preferred
• At least one relevant certification (e.g., CPC, CIC, CRC, CPMA) is preferred