Nurse Itemized Bill Reviewer, IBR Analyst

🕒 Abril 23

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $80.000 - $90.000 / ano

⏰ Tempo Integral

🟢 Júnior

🧐 Analista

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Machinify

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

⚕️ Seguro de Saúde

🤖 Inteligência Artificial

☁️ SaaS

💰 $10.000.000 Series A - Machinify em 2018-10

Healthcare Insurance • Artificial Intelligence • SaaS

A Machinify é uma empresa de plataforma e serviços de IA focada em saúde que transforma pagamentos e a integridade de pagamentos no setor. Seu sistema operacional de IA unifica reivindicações, prontuários médicos, contratos e políticas, utilizando modelos fundamentais e agentes específicos de tarefas para automatizar e aprimorar a codificação, precisão de pagamentos, recuperações e prevenção de custos. A Machinify atende planos de saúde (incluindo 18 dos 20 maiores), oferece implantações internalizadas, híbridas ou totalmente gerenciadas e enfatiza resultados mensuráveis — relatando mais de 85 clientes, 270 milhões de vidas cobertas e mais de 6 bilhões de dólares em prevenção de custos e recuperações anuais.

Descrição

• Perform an in-depth review of medical claims utilizing the UB-04 and detailed itemized statement to ensure the validity of line-item charges. • Verify accuracy of the itemized charges to be reimbursed according to client policy and industry standards. • Validate automatic system denials and create additions to enhance efficient processing of IBR claims. • Recommend system enhancements and edits to improve claim review efficiency. • Comply with company standards regarding accuracy and productivity to manage daily assignments and meet client turnaround times. • Consult with Senior Analysts with any questions and/or issues related to claim reviews. • Assist in content development, automation, research, and appeal responses as needed. • Provide input and collaboration concerning content development with internal groups and on global projects as needed. • Attend all required meetings. • Assists in special projects and perform other duties as needed.

🎯 Requisitos

• Active RN, LPN, or LVN license in good standing • Equivalent experience of 1+ years in itemized bill review • Equivalent experience of 2+ years in healthcare billing and coding • Experience applying payer policies and national coding guidelines such as CPT, ICD-9/10, and HCPCS • Ability to research and verify billing and coding accuracy • Possess significant attention to detail and excellent written and verbal skills • Excellent organizational, analytical, and problem-solving skills • Capable of handling multiple projects in a fast paced, hyper-growth environment • Strong ability to work independently and work with internal teams communicating change across the business

🏖️ Benefícios

• Work from anywhere in the US! Machinify is digital-first. • Top Medical/Dental/Vision offerings • FSA/HSA • Tuition reimbursement • Competitive salary, 401(k) with company match • Additional health and wellness benefits and perks • Flexible and trusting environment where you’ll feel empowered to do your best work