Job Summary:

The Itemized Bill Reviewer position has an extensive background in facility-based coding practices, CMS billing rules and state specific reimbursement guidelines to include, but not limited to, high-cost outliers and repricing. This position is responsible for interpreting payer reimbursement policies and building rules to adhere to appropriate billing practices on inpatient itemized bills. This position is fully responsible for maintaining the accuracy of the rules and completing audits to ensure accuracy that drives high quality recoverable dollars for the benefit of our clients.

Benefits:

• Remote-first flexible working environment
• Health insurance, including $0 premium HDHP and $0 deductible PPO options
• Vision, Dental
• Company-paid Telemedicine
• Company-paid Life Insurance
• Company-paid STD
• Voluntary LTD
• Voluntary Life Insurance
• FIRST-DAY COVERAGE for all benefits above
• 401(k) with matching, immediate vesting
• Generous Paid Time Off, including Vacation, Wellness, Floating Holidays, and Volunteer Time Off

You may be ideal if you have:

• High School Diploma / GED (or higher)
• 5+ years of performing inpatient acute care hospital itemized bill reviews, high-cost outlier reimbursement and repricing of allowed charges
• CCS or CIC certification
• CPC certification
• Experience with ICD - 10 CM and DRG coding
• Positive, self-motivated, and driven
• Focused on team performance with the ability to knowledge share
• High standard of personal integrity and accountability
• Passion and aptitude for solving complex problems
• Fun attitude and great sense of humor!

Responsibilities:

• Investigate, review, and provide coding expertise in the application of billing practices and reimbursement policies within the claim adjudication process through a thorough document review.
• Complete high-quality reviews to ensure accuracy of medical coding and billing practices on itemized bills.
• Generate and maintain rule-based criteria for itemized bill reviews as annual updates occur and client specific requirements are understood.
• Knowledge of and the ability to: identify the ICD-10-CM/PCS code assignment, code sequencing, and discharge disposition, in accordance with CMS requirements, Official Guidelines for Coding and Reporting, and Coding Clinic guidance.
• Must be fluent in the application of current CMS guidelines citations (NCCI edits, MUE, PTP, OPPS, etc.), in addition to demonstrating working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments.
• Solid command of anatomy and physiology, diagnostic procedures, and surgical operations.
• Writes clear, accurate and concise rationales in support of findings.
• Maintain and manage daily case review assignments with a high emphasis on quality.
• Provide support and expertise to the other investigative and analytical areas.
• Will be working in a high-volume production environment.

Other Duties:

This job description in no way states or implies that these are the only duties to be performed by this employee. This position will require you to follow other instructions and perform other duties requested by his/her supervisor. Individuals will always be expected to maintain a professional work environment.

About ClarisHealth:

ClarisHealth, based in Nashville, Tenn., provides health plans and payers with a better way to drive claims payment accuracy. Its proprietary, A.I.-powered enterprise technology platform Pareo® allows health plans across the U.S. to reduce manual work, gain insights into operational performance across lines of business, and accelerate their strategy to overpayment prevention – at a significantly reduced cost.

Company Culture:

Our company values help everyone move in alignment toward this mission. We are …

Compassionate. We practice servant leadership, encourage inclusion and engagement, and actively acknowledge and celebrate each other’s contributions.

Communicators. We listen first with an emphasis on understanding. We seek solutions to problems, and practice radical candor with positive intent.

Challengers. We get the right stuff done right, create clarity from complexity, take accountability and ownership, and we challenge ourselves daily.

ClarisHealth embraces a supportive working culture of creativity and innovation internally termed “Got Your Back.” We live out this #GYB spirit every day by working together with team members, clients, and other partners to achieve shared goals.

For more information about ClarisHealth and our culture, please visit us at https://www.clarishealth.com/careers/.

Other

Applicants must be currently authorized to work in the United States on a full-time basis. ClarisHealth is not able to sponsor applicants for work visas.

EOE, including Disability/Veterans; anyone needing accommodation to complete the interview process should notify the People Operations team.