State Licensed Clinical Bill Reviewer

Job Summary

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

Key responsibilities

• Review and analyze provider disputes concerning Payment Integrity audit findings
• Validate charges and assess the accuracy of billed services by comparing itemized bills and claim forms against medical records
• Develop clear, well-supported written responses to provider disputes while managing a high-volume queue of cases

Required qualifications

• Active RN license required
• 3+ years of experience in Payment Integrity, medical bill review, or clinical auditing
• Hands-on experience in reviewing provider appeals and disputes related to Payment Integrity findings
• Strong knowledge of medical billing, coding, and clinical documentation
• At least one relevant certification preferred (CPC, CIC, CRC, CPMA, or equivalent)