Nurse Itemized Bill Reviewer (IBR Analyst)

About the Opportunity

As part of the Complex Payment Solutions team, you will, as a Nurse Itemized 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.