State Licensed Clinical Bill Reviewer (RN, CPC)

Job Summary

To support a growing healthtech startup, the full-time remote State Licensed Clinical Bill Reviewer (RN, CPC) will review and analyze medical claims, patient medical records, and automatic audit results while performing high-dollar facility bill reviews.

Key responsibilities

• Review UB-04/IB forms for coding/billing violations and validate charges against medical records
• Audit revenue codes against clinical documentation and confirm services billed were rendered
• Document inconsistencies between claims billed and health plan payments, ensuring compliance with national and payer-specific guidelines

Required qualifications

• Clinical license (RN) required
• Facility inpatient coding/auditing experience
• At least one relevant certification (CPC/CIC/CRC/CPMA) or willingness to obtain within one year
• Minimum of 3 years of auditing/bill review experience
• Deep background in medical billing, coding, or auditing of insurance claims and medical records