Itemized Bill Review Coder Auditor, Lead Associate

🕒 September 14

🇺🇸 United States – Remote

💵 $60.1k - $85.8k / year

⏰ Full Time

🟠 Senior

🔎 Auditor

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Perform quality audits of itemized bill reviews for accuracy, consistency, compliance, and proper documentation • Validate audit findings by reviewing itemized bills, medical records, claims, contracts, fee schedules, and supporting documentation • Evaluate billing errors, duplicate charges, unsupported services, coding, modifiers, units, reimbursement methods, and compliance requirements • Conduct complex audits of institutional claims, itemized bills, and medical records • Review inpatient, outpatient, emergency, ambulatory surgery, and ancillary service charges • Assess revenue codes, charge capture practices, HCPCS, CPT, ICD-10 support, and payer requirements • Identify payment integrity opportunities through billing and reimbursement reviews • Serve as a subject matter expert in business proposals • Assist with training, mentoring, and educating new reviewers • Maintain current clinical and coding knowledge and cross-train across multiple claim types • Support client needs and departmental quality and performance goals

🎯 Requirements

• Associate degree in Health Information Management, Nursing, Healthcare Administration, Business Administration, or related healthcare field required • Certified Coder or Registered Nurse with Coding Experience • RHIA, RHIT, CCS, CIC, CPMA, CCDS, COC or CPC coding certification preferred • Comprehensive knowledge of Revenue Codes, CPT, HCPCS, ICD-10 Coding Guidelines, Charge Master structure, UB-04 billing requirements, APC, ASC, OPPS, and DRG reimbursement methodology • Advanced knowledge of hospital billing practices, itemized bill review methodologies, and payment integrity concepts • Ability to interpret and apply payer contracts, billing regulations, and reimbursement guidelines • 3+ years Itemized Bill Review or Hospital Bill Audit experience required • 3+ years of outpatient auditing experience with expert knowledge of ICD-10 Official Coding • 3+ years medical record review experience or claims auditing preferred • 5 years of healthcare billing, coding, payment integrity, revenue cycle, or itemized bill review experience required • Experience auditing high-dollar institutional claims • Experience auditing hospital itemized bills and institutional claims required • Extensive experience reviewing hospital inpatient and outpatient billing practices • Work location within the continental US • High-speed internet connection and distraction-free work environment • Ability to work during normal business hours • May be required to work extended hours for special business needs • May be required to travel at least 10% of the time

🏖️ Benefits

• Flexible hours and work flexibility • Work-life balance • Continuous learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies