Medical Itemized Bill Reviewer (IBRL-1 Analyst)

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Skills

Windows
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Microsoft Word
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Microsoft PowerPoint
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Education

Bachelor's degree
 
Job details
Here’s how the job details align with your profile.
Job type

Full-time
 
Benefits
Pulled from the full job description
401(k) matching
Dental insurance
Disability insurance
Flexible spending account
Health insurance
Life insurance
Paid holidays
 
Full job description
Who We Are

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Location: This role is full remote

About the Opportunity

At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Complex Payment Solutions team, you will, as an Medical Itemized Bill Reviewer (IBR Level 1 Analyst), be responsible for reviewing insurance claims to determine true and accurate charges. This role requires the analysis of the UB-04, the detailed itemized statement, and medical documentation when provided. The analyst will apply the client policy and industry standards when reviewing these claims. This role must identify billed items and services that do not meet the appropriate compliance guidelines. This role requires clinical expertise, as well as previous payment integrity experience.

What you’ll do

Perform an in-depth review of medical claims utilizing the UB-04 and detailed itemized statement to ensure the validity of line-item charges.
Verify accuracy of the itemized charges to be reimbursed according to client policy and industry standards.
Validate automatic system denials and create additions to enhance efficient processing of IBR claims.
Recommend system enhancements and edits to improve claim review efficiency.
Comply with company standards regarding accuracy and productivity to manage daily assignments and meet client turnaround times.
Consult with Senior Analysts with any questions and/or issues related to claim reviews.
Assist in content development, automation, research, and appeal responses as needed.
Provide input and collaboration concerning content development with internal groups and on global projects as needed.
Attend all required meetings.
Assists in special projects and perform other duties as needed.
Bachelor’s degree (health administration, business, nursing)
Equivalent experience of 1+ years in itemized bill review
Equivalent experience of 2+ years in healthcare billing and coding
Experience and background in healthcare payment integrity industry required
Possess significant attention to detail and excellent written and verbal skills
Excellent organizational, analytical, and problem-solving skills
Capable of handling multiple projects in a fast paced, hyper-growth environment
Strong ability to work independently and work with internal teams communicating change across the business
Computer Equipment and Software:

Experience working with multiple monitors
Proven success in a remote working environment
Proficient in Windows office systems, including the full Microsoft Suite and Teams
Advanced skills in Microsoft Office (Excel, PowerPoint, Word)
Experience with various software applications and collaboration with development teams
What Success Looks Like…

After 3 months

You will have a strong understanding of the role.
You begin building relationships and collaborating with peers.
You develop effective time and priorities management.
You receive initial feedback about your performance and are using it to improve.
You’ve gained confidence in your abilities and are starting to feel more comfortable in your role.
After 1 year

You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.
You have established a strong network of internal relationships and are recognized as a key collaborator.
You’ve been entrusted with greater responsibility indicating the company’s confidence in your abilities.
You see opportunities for career progression and personal development.
Pay range: $75,000-$+0,000 USD

This is an exempt position. The salary range is for Base Salary. Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee’s geographic location.

What’s in it for you

PTO, Paid Holidays, and Volunteer Days
Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
Tuition Reimbursement
Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
Remote and hybrid work options
What values we’ll share with you

Ask why
Think big
Be humble
Optimize for customer impact
Deliver results
At Machinify, we’re reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative, accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we’re passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, ****** orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer.

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