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

MG5uZkN4bGJXZW1Id0lJUUlFZ2hDc2Z1TVE9PQ==
  • 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

Crown Residential LLC

Assistant Service Supervisor Job at Crown Residential LLC

 ...perform service duties in addition to exemplifying complete knowledge of all equipment and appliances, express interest in accepting management functions delivered by the Service Supervisor and are involved in creating and developing relationships with vendors.... 

Regeneron

Associate Director, Precision Medicine Operations Job at Regeneron

 ...Regeneron's Precision Medicine organization is seeking an Associate Director to join our team! In this role, a typical day may include:...  ...will receive consideration for employment without regard to race, color, religion or belief (or lack thereof), sex, nationality,... 

Corning Incorporated

Instrument Electrician Job at Corning Incorporated

 ...Requisition Number: 70407 The company built on breakthroughs. Join us. Corning is one of the worlds leading innovators in glass, ceramic, and materials science. From the depths of the ocean to the farthest reaches of space, our technologies push the... 

Language Trainers

ID: 1072217 | Italian Language Teacher needed in Fort Worth,TX Job at Language Trainers

 ...family or travel reasons. Founded in 2004, the companys motto is Any Language, Anytime, Anywhere! We might have a job for you as an Italian teacher. Reference number: 1072217 Some details about the course: One of our clients in Fort Worth would like to have two-to-... 

ATC Midland

LPN Corrections Job at ATC Midland

The Corrections Licensed Practical Nurse ( LPN ) works inside a correctional facility. This position is responsible for providing care...  ...health systems, multi-unit senior care companies, governments, school systems, VMS and MSP vendors trust us to deliver more than 100,0...