United States onlyMachinify 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 85 health plans, including many of the top 20, and representing more than 270 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.
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 a NurseItemized Bill Reviewer (IBR Analyst), be responsible for reviewing facility 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 itemized bill review 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.
What experience you bring (Role Requirements)
- Active RN, LPN, or LVN license in good standing
- Equivalent experience of 1+ years in itemized bill review
- Equivalent experience of 2+ years in healthcare billing and coding
- Experience applying payer policies and national coding guidelines such as CPT, ICD-9/10, and HCPCS
- Ability to research and verify billing and coding accuracy
- 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 We Offer:
- Work from anywhere in the US! Machinify is digital-first.
- Top Medical/Dental/Vision offerings
- FSA/HSA
- Tuition reimbursement
- Competitive salary, 401(k) with company match
- Additional health and wellness benefits and perks
- Flexible and trusting environment where you’ll feel empowered to do your best work
