Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.
About Our Opportunity
As a Bill Review Analyst, you will pre-screen claims to identify unbundled charges and billing errors, resolving escalated cases that require coding expertise. 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 overcharges, unbundled codes and other discrepancies.
- Ensure codes are accurate and relevant and verify the correct use of modifiers.
- Stay updated on medical coding guidelines and regulations.
- Ensure adherence to national and industry billing standards by verifying the proper use of codes and accurately applying bundling and unbundling rules.
- 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.
What You’ll Bring to the Team: - 3+ years of auditing, claims, review and/or billing experience with a healthcare organization
- CPC and/or CIC certifications
- Encoder Pro and/or Find-A-Code software experience
- Experience in bill review and line charge verifications
- 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
- Knowledge of Health Insurance, Medicare guidelines and various healthcare programs
- Experience with TPAs, MGUs, Brokers and Stop Loss clients
Where You’ll Work:
This is a fully remote position, and we’ll provide all the necessary equipment!
- Work Environment: You’ll need a quiet workspace that is free from distractions.
- Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
- Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
- Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA
Why You'll Love Working Here
Valenz is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do.
Benefits
- Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
- Spending account options: HSA, FSA, and DCFSA
- 401K with company match and immediate vesting
- Flexible working environment
- Generous Paid Time Off to include vacation, sick leave, and paid holidays
- Employee Assistance Program that includes professional counseling, referrals, and additional services
- Paid maternity and paternity leave
- Pet insurance
- Employee discounts on phone plans, car rentals and computers
- Community giveback opportunities, including paid time off for philanthropic endeavors
At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.