Nurse Itemized Bill Reviewer (IBR Analyst)
Offer summary
Qualifications:
Active RN, LPN, or LVN license in good standing., At least 1 year of experience in itemized bill review., Over 2 years of healthcare billing and coding experience., Proficiency in payer policies and coding guidelines like CPT, ICD-10, and HCPCS..Key responsibilities:
- Review medical claims to verify the accuracy of charges.
- Ensure claims comply with client policies and industry standards.
- Collaborate with senior analysts and participate in content development.
- Manage multiple projects in a fast-paced environment.
Job description
Job Details
Level: Experienced Job Location: California Office Roseville, CA Position Type: Full Time Salary Range: $75000.00 $90000.00 Salaryyear Job Shift: Day Job Category: Health Care Nurse Itemized Bill Reviewer (IBR Analyst)
Who We Are
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and contentrich, AIpowered platform along with bestinclass expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
Location: This role is full remote
About the Opportunity
At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions team, you will, as a Nurse Itemized Bill Reviewer (IBR Analyst), be responsible for reviewing facility insurance claims to determine true and accurate charges. This role requires the analysis of the UB04, the detailed itemized statement, and medical documentation when provided. The analyst will apply the client policy and industry standards when reviewing these claims. This role must identify billed items and services that do not meet the appropriate compliance guidelines. This role requires clinical expertise, as well as previous itemized bill review experience.
What you’ll do
- Perform an indepth review of medical claims utilizing the UB04 and detailed itemized statement to ensure the validity of lineitem 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 andor 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.
-
Qualifications
What experience you bring (Role Requirements)
- 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, ICD910, 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 problemsolving skills
-
- Capable of handling multiple projects in a fast paced, hypergrowth environment
-
- Strong ability to work independently and work with internal teams communicating change across the business
-
Computer Equipment and Software:
- Experience working with multiple monitors
-
- Proven success in a remote working environment
-
- Proficient in Windows office systems, including the full Microsoft Suite and Teams
-
- Advanced skills in Microsoft Office (Excel, PowerPoint, Word)
-
- Experience with various software applications and collaboration with development teams
-
What Success Looks Like…
After 3 months
- You will have a strong understanding of the role.
-
- You begin building relationships and collaborating with peers.
-
- You develop effective time and priorities management.
-
- You receive initial feedback about your performance and are using it to improve.
-
- You’ve gained confidence in your abilities and are starting to feel more comfortable in your role.
-
After 1 year
- You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.
-
- You have established a strong network of internal relationships and are recognized as a key collaborator.
-
- You’ve been entrusted with greater responsibility indicating the company’s confidence in your abilities.
-
- You see opportunities for career progression and personal development.
-
Pay range: $75,000$90,000 USD
This is an exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.
What’s in it for you
- PTO, Paid Holidays, and Volunteer Days
-
- Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
-
- Tuition Reimbursement
-
- Eligibility for companypaid benefits including life insurance, shortterm disability, and parental leave.
-
- Remote and hybrid work options
-
What values we’ll share with you
- Ask why
-
- Think big
-
- Be humble
-
- Optimize for customer impact
-
- Deliver results
-
At Machinify, we’re reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.
Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work crossfunctionally, abandoning silos, to bring innovative and accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we’re passionate about a future with better outcomes for all.
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in EVerify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please contact our People Operations team at peopleoperations@rawlingscompany.com. See our Candidate Privacy Notice at: https:www.machinify.comcandidateprivacynotice
Nurse Itemized Bill Reviewer (IBR Analyst)
Who We Are
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and contentrich, AIpowered platform along with bestinclass expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
Location: This role is full remote
About the Opportunity
At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions team, you will, as a Nurse Itemized Bill Reviewer (IBR Analyst), be responsible for reviewing facility insurance claims to determine true and accurate charges. This role requires the analysis of the UB04, the detailed itemized statement, and medical documentation when provided. The analyst will apply the client policy and industry standards when reviewing these claims. This role must identify billed items and services that do not meet the appropriate compliance guidelines. This role requires clinical expertise, as well as previous itemized bill review experience.
What you’ll do
- Perform an indepth review of medical claims utilizing the UB04 and detailed itemized statement to ensure the validity of lineitem 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 andor 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.
-
- 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, ICD910, 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 problemsolving skills
- Capable of handling multiple projects in a fast paced, hypergrowth environment
- Strong ability to work independently and work with internal teams communicating change across the business
-
- Experience working with multiple monitors
- Proven success in a remote working environment
- Proficient in Windows office systems, including the full Microsoft Suite and Teams
- Advanced skills in Microsoft Office (Excel, PowerPoint, Word)
- Experience with various software applications and collaboration with development teams
-
- You will have a strong understanding of the role.
- You begin building relationships and collaborating with peers.
- You develop effective time and priorities management.
- You receive initial feedback about your performance and are using it to improve.
- You’ve gained confidence in your abilities and are starting to feel more comfortable in your role.
-
- You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.
- You have established a strong network of internal relationships and are recognized as a key collaborator.
- You’ve been entrusted with greater responsibility indicating the company’s confidence in your abilities.
- You see opportunities for career progression and personal development.
-
- PTO, Paid Holidays, and Volunteer Days
- Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
- Tuition Reimbursement
- Eligibility for companypaid benefits including life insurance, shortterm disability, and parental leave.
- Remote and hybrid work options
-
- Ask why
- Think big
- Be humble
- Optimize for customer impact
- Deliver results
-
At Machinify, we’re reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.
Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work crossfunctionally, abandoning silos, to bring innovative and accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we’re passionate about a future with better outcomes for all.
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in EVerify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please contact our People Operations team at peopleoperations@rawlingscompany.com. See our Candidate Privacy Notice at: https:www.machinify.comcandidateprivacynotice
What values we’ll share with you
Pay range: $75,000$90,000 USD
This is an exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.
What’s in it for you
After 1 year
What Success Looks Like…
After 3 months
Computer Equipment and Software:
Qualifications
What experience you bring (Role Requirements)
Required profile
Experience
Other Skills
- Non-Verbal Communication
- Analytical Skills
- Organizational Skills
- Detail Oriented
- Microsoft Office
- Virtual Teams
- Time Management
- Collaboration
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