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Certified Medical Claims Auditor
Vālenz® HealthCertified Medical Claims Auditor reviewing billing and coding discrepancies for Valenz Health. Providing insights to ensure accurate claims and improve client outcomes as part of a remote team.
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- 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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
auditingclaims reviewbillingICD-10CPTHCPCS Revenue codesDRG validationnegotiationprocess improvementspolicy development
Soft Skills
communicationmentoringcollaborationproblem-solvinganalytical skillsattention to detailclient satisfactiontrainingresearchdispute resolution
Certifications
CPCCIC