To support a growing Appeals and Disputes team, the full-time Clinical Bill Reviewer (RN License) will review and investigate provider disputes related to Payment Integrity findings, focusing on high-dollar facility claims and itemized bills in a remote work environment. Key responsibilities Review and investigate provider disputes related to Payment Integrity audit findings Analyze itemized bills, UB-04 claim forms, medical records, and clinical documentation to assess billing accuracy Develop clear, well-supported written responses to provider disputes while managing a high-volume case queue Required qualifications 3+ years of experience in Payment Integrity, medical bill review, or claims auditing Hands-on experience with itemized bill reviews and high-dollar facility claims Deep knowledge of medical billing, coding, and clinical documentation Active RN license preferred At least one relevant certification (e.g., CPC, CIC, CRC, CPMA) is preferred
Clinical Bill Reviewer (RN License) • Concord, California, United States
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