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Kyle Wagehoft
Director of Staffing | Healthcare, Revenue Cycle Management, Accounting, Information Technology, Finance, and Human Resources
Our client is a high-growth, venture-backed startup, dedicated to revolutionizing the U.S. healthcare system. They encourage collaboration among individuals with diverse backgrounds and ideologies to drive innovation. If you're passionate about leveraging cutting-edge technologies to make a significant impact on U.S. healthcare, we invite you to join this company’s mission-driven team.
As a Medical Claims Analyst, you will play a crucial role in automating medical claim audits. You will review claim forms, patient medical records, and audit results to train their AI-driven platform. The primary responsibilities include identifying coding/billing violations, auditing revenue codes against clinical documentation, and ensuring accuracy in claims billed versus health plan payments.
This Role Offers:
Medical, Dental, and Vision benefits
Flexible, paid vacation policy
Work in a flat organizational structure with direct access to leadership.
Focus:
Itemized Bill Review Experience Required
Review UB-04/IB forms for coding/billing violations.
Audit revenue codes against clinical documentation.
Confirm services billed were rendered.
Document inconsistencies in claims versus health plan payments.
Validate automatic audit results based on national and payer-specific guidelines.
Skill Set:
Facility inpatient coding/auditing experience is required.
Extensive experience in medical billing, coding, or auditing of insurance claims and medical records.
Familiarity with national coding guidelines such as CPT codes, ICD-9/10, HCPCS codes, DRGs, APCs, etc.
Knowledge of hospital-based billing/coding and PHI/HIPAA compliance
At least three years of experience in auditing and reviewing medical bills.
One of the following certifications is mandatory: CPC/COC/CIC/CRC/CPMA
Clinical license preferred (RN)
Experience working at an insurance company is preferred.
Must be based in New York.
100% remote work considered for the right candidate.
About Blue Signal:
Blue Signal is a leading executive search firm specializing in healthcare recruiting. Our healthcare recruiters have expertise in placing high-performing talent in healthcare IT, medical devices, biotechnology, pharmaceuticals, etc. Learn more at bit.ly/3G5DbWr
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Accounting/Auditing, Information Technology, and Health Care Provider
Industries
Health and Human Services
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