Certified Medical Claims Auditor

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🕒 3 days ago

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Vālenz® Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2004

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

Healthcare Insurance • Fintech • SaaS

Vālenz® Health is a comprehensive health plan solutions provider that offers a fully integrated platform designed to simplify the complexities of healthcare for employers, payers, providers, and members. The company focuses on enhancing quality and lowering costs through data-driven insights, member navigation, provider networks, and robust claims management. By connecting various stakeholders in the healthcare ecosystem, Vālenz aims to improve health outcomes and streamline the healthcare experience for all involved.

📋 Description

• Review medical bills to identify appropriate billing, coding, and savings opportunities. • Analyze and resolve claim discrepancies that require a deeper level of expertise beyond initial review. • Collaborate with the Negotiation team to resolve more complex claim issues and secure additional savings. • Communicate findings to clients through detailed Bill Review Reports and assist in discussing complex bill-related inquiries. • Evaluate and respond to bill reconsideration requests, including those requiring additional research or analysis. • Handle escalated provider inquiries, resolve disputes, and conduct direct negotiations for billing discrepancies. • Provide guidance and mentor junior analysts in claim review best practices. • Assist in identifying trends in billing issues, proposing system/process improvements, and contributing to policy development. • Support training efforts by educating internal teams and clients on changes to codes, edits, and bill review procedures. • Work cross-functionally with internal teams to identify and implement process efficiencies that improve savings and client satisfaction. • Ensure compliance with HIPAA and other regulatory standards. • Perform other duties as assigned.

🎯 Requirements

• 3+ years of auditing, claims, review and/or billing experience within a healthcare organization. • CPC and/or CIC certification • Working knowledge of industry coding, ICD-10, CPT, HCPCS Revenue codes etc. • Excellent communication skills, both verbal and written. • Knowledge of CMS guidelines • A plus if you have: Experience in DRG validation. • Knowledge of Health Insurance, Medicare guidelines and various healthcare programs. • RevCycle Pro, Encoder Pro, and/or SuperCoder software experience.

🏖️ Benefits

• Competitive benefits package with generous employer subsidies • Flexible and remote working options • 401k with generous employer match and immediate vesting • Personal and professional development opportunities • Supportive family benefits, including paid leave for new family members • Companywide philanthropic program, Valenz Communities Connection