Itemized Bill and Medical Record Reviewer Job at Alaffia Health, New York, NY

dS9rZ2tFeHBvZFBIVi9xQnhrcW9YczlmZnc9PQ==
  • Alaffia Health
  • New York, NY

Job Description

About Alaffia & Our Mission

Each year, the U.S. healthcare system suffers from over $500B in wasted spending due to medical billing fraud, waste, and administrative burden. At Alaffia, we’re on a mission to change that. We’ve assembled a team of clinicians, AI/ML engineers, and product experts to build advanced AI that finally bends the cost curve for all patients across our ecosystem. We’re a high-growth, venture-backed startup based in NYC and are actively scaling our company.

About the Role & What You’ll Be Doing

We are looking for a Medical Bill reviewer to join our team! Do you have experience reviewing claim forms and auditing provider documentation? Then this position is for you! You will work alongside our team to empower our clients with technology that will modernize medical claim auditing.

You will be responsible for reviewing and analyzing medical claims, patient medical records, and automatic claim audit results to help train our machines to deliver automated audit results. You will be performing high-dollar facility bill reviews. Your role will be integral to your engineering teams and will help inform decisions that will shape the future of healthcare we aim to see.

Your Responsibilities

  • Combing through UB-04/IB's for any potential coding/billing violations
  • Comparing the IB/UB-04 against the medical record to validate charges and assess the quality of the medical record
  • Auditing revenue codes against clinical documentation
  • Confirmation of services billed were rendered
  • Clear documentation of inconsistencies with claims billed vs health plan payments
  • Confirming automatic audit results based on national and payer-specific guidelines

What We’re Looking For

  • FACILITY INPATIENT CODING/AUDITING EXPERIENCE REQUIRED
  • Clinical license required (RN) preferred
  • Experience working at an insurance company (preferred)
  • Experience performing audits on line item charges on Itemized Bills
  • Deep background in medical billing, coding, or auditing of insurance claims and medical records
  • Experience working with national guidelines such as CPT codes, ICD-9/10, HCPCS codes, POS codes, DRGs, APCs, and other code sets and the translation of written clinical information into auditable clinical content.
  • Knowledge of hospital-based billing/coding
  • Knowledge of PHI/HIPAA compliance and standards
  • Ability to research and verify claim coding accuracy
  • Minimum of 3 years of auditing/bill review experience
  • At least one of the following certifications is mandatory (CPC/CIC/CRC/CPMA)

Our Culture

At Alaffia, we fundamentally believe that the whole is more valuable than the sum of its individual parts. Further to that point, we believe a diverse team of individuals with various backgrounds, ideologies, and types of training generates the most value. If you want to work alongside driven people on a mission to make a major impact at the core of U.S. healthcare by implementing the latest in cutting-edge technologies, then we’d like to meet you!

What Else Do You Get Working With Us?

  • Medical, Dental, and Vision benefits
  • Flexible, paid vacation policy
  • Work in a flat organizational structure — direct access to Leadership

LI-REMOTE

Job Tags

Flexible hours,

Similar Jobs

GovGig

Quality Control Manager Job at GovGig

 ...The CQC Manager will be assigned to Department of Defense (DOD) construction project(s) located in various regions. This individual...  ...the jobsite, the CQC Manager works with the customer and other contractor staff to ensure CQC objectives are met in accordance with the... 

Professional Alternatives

Recruiter Job at Professional Alternatives

 ...leading compensation plan Professional Alternatives is growing, and our award-winning team is hiring focused and results-driven recruiters to join us! The ideal applicant will be a strong leader, have excellent relationship-building skills, be self-motivated with a... 

Stew Leonard's

Construction Assistant Job at Stew Leonard's

 ...the store that keep children entertained while parents shop. Construction Assistant Full Time Hourly- Estimated pay range $20-$22 per...  ...and complete installations as capable and as necessary. Cleaning and maintenance of the shop and refrigerated cases. Assisting... 

Garney Construction

Regional Operations Manager Job at Garney Construction

 ...Regional Operations Manager Garney Construction is seeking a Regional Operations Manager in McKinney, TX. This role is responsible for overseeing construction operations and business performance across multiple areas or geographic regions. This role provides leadership... 

Palm Health Resources

Oncology Nurse Practitioner Job at Palm Health Resources

 ...We are hiring and experienced OB/Gynecology Physician Assistant or Nurse Practitioner locum to come out to Seattle, WA and support our team during a LOA. This LOCUM TENEN role will be approximately four (4) months in length and work with one of the premier teams in the...