RN Clinical Bill Reviewer

Job Summary

Seeking a full-time RN Clinical Bill Reviewer with CPC certification to remotely analyze medical claims, audit provider documentation, and ensure compliance with billing guidelines while collaborating with engineering teams to enhance automated auditing processes.

Key responsibilities

• Reviewing UB-04/IB claims for coding and billing violations
• Validating charges by comparing claims against medical records
• Documenting inconsistencies between billed claims and health plan payments

Required qualifications

• Current RN clinical license
• At least one certification (CPC/CIC/CRC/CPMA) or willingness to obtain within one year
• Minimum of 3 years of auditing or bill review experience
• Experience with national guidelines such as CPT, ICD-9/10, and HCPCS codes
• Knowledge of PHI/HIPAA compliance and hospital-based billing/coding