Valenz Health
Description
Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.
About Our Opportunity:
As the Medical Bill Review Auditor (aka: Bill Review Analyst III), you will pre-screen claims to identify unbundled charges and billing errors. You will perform in-depth reviews based on accepted billing practices and coding rules. With this information, you will provide timely insights to our internal teams and management to achieve savings for clients.
To be successful in this role, you will be a strong communicator, possess excellent problem solving skills, and a knack for detail and organization.
Things You’ll Do Here:
- Identify correct billing and savings on claims by running the codes through programs.
- Work collaboratively with the Negotiation team to resolve claim issues and obtain additional discount.
- Communicate all findings to clients by providing a Bill Review Report that can be reviewed with clients at their request.
- Evaluate and respond to bill reconsideration requests.
- Communicate with providers to query or to resolve billing discrepancies and respond to appeals.
- Educate staff and clients on any updated information on codes/edits.
- Formulate and document department processes and policies.
- Track and trend bill review.
- Partner with team and direct supervisor in achieving departmental goals and suggestions that will increase revenue relating to Bill Review.
- Comply with/supports HIPAA standards.
- Identify system/process issues and communicate potential resolutions.
Reasonable accommodations may be made to enable individuals with disabilities to perform essential duties.
What You’ll Bring to the Team:
- 3+ years of auditing and/or reviewing medical bills/claims
- Experience ensuring overall accuracy of a bill/claim reviewing medical codes, itemized or duplicate charges, etc.
- 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
- CPC and/or CIC certifications
- Knowledge of Health Insurance, Medicare guidelines and various healthcare programs
- RevCycle Pro, Encoder Pro, and/or SuperCoder software experience
Where You’ll Work: This role is remote.
Why You Will Love Working Here:
We offer employee perks beyond standard benefits and compensation packages – see below! At Valenz, our team is committed to delivering on our promise to engage early and often for more innovative, better, and faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You’ll find limitless growth opportunities as we grow together. If you’re ready to utilize your skills and passion for making a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!
Perks and Benefits:
- Generously subsidized company-sponsored medical, dental, and vision insurance
- Company-funded HRA
- 401K with company match and immediate vesting
- Flexible working environment
- Responsible Paid Time Off
- Paid maternity and paternity leave
- Paid company holidays
- Community giveback opportunities, including paid time off for philanthropic endeavors