Itemized Bill Review Quality Auditor, Lead Associate- Remote

Summary

We are seeking a talented individual for a Lead Associate, Itemized Bill Review Quality Auditor to perform reviews of medical records, healthcare claims, itemized medical bill, and UB-04 forms to ensure accuracy, compliance, and proper billing practices. This role is responsible for conducting quality assurance audits and oversight of itemized bill review activities to ensure accuracy, consistency, regulatory compliance, and alignment with client-specific review methodologies. This role serves as a subject matter expert in hospital billing, reimbursement methodologies, payment integrity, and claim auditing.

The Lead Associate performs comprehensive quality reviews of itemized bill audits completed by clinical and coding review staff, validates audit findings, and provides regulatory and reimbursement support for determination decisions. This position requires extensive knowledge of hospital charging practices, revenue codes, UB-04 billing requirements, CMS reimbursement methodologies, NCCI edits, and payment integrity concepts. The individual is expected to identify opportunities for quality improvement, provide staff education and mentoring, and support the achievement of departmental quality and performance goals.

Your role in our mission

What we're looking for

• Associate degree in Health Information Management, Nursing, Healthcare Administration, Business Administration, or related healthcare field required.
• Certified Coder or Registered Nurse with Coding Experience. One of the following Coding Certifications preferred: RHIA, RHIT, CCS, CIC, CPMA, CCDS, COC or CPC
• Comprehensive knowledge of Revenue Codes, CPT, HCPCS, ICD-10 Coding Guidelines, Charge Master structure, UB-O4 billing requirements, APC, ASC, OPPS, DRG reimbursement methodology.
• Advanced knowledge of hospital billing practices, itemized bill review methodologies, and payment integrity concepts.
• Ability to interpret and apply payer contracts, billing regulations, and reimbursement guidelines.
• 3+ years Itemized Bill Review or Hospital Bill Audit experience required
• 3+ years of outpatient auditing experience with expert knowledge of ICD-10 Official Coding
• 3+ years medical record review experience or claims auditing preferred
• 5 years of healthcare billing, coding, payment integrity, revenue cycle, or itemized bill review experience required.
• Experience auditing high-dollar institutional claims.
• Experience auditing hospital itemized bills and institutional claims required.
• Extensive experience reviewing hospital inpatient and outpatient billing practices.

What you should expect in this role

• Home based position and you must have a work location within the continental US
• This position requires that you provide high speed internet connection and a work environment free from distractions
• Ability to work during normal business hours as this position requires frequent interactions with the team and other departments within the company
• May be required to work extended hours for special business needs
• May be required to travel at least 10% of time based on business needs

Will accept application until October 23, 2026.