Job Title : Nurse - Medical Bill Reviewer
Location : Remote
Type : Full-time
Position Summary
We are seeking a detail-oriented and knowledgeable Medical Bill Reviewer who can review, validate, and apply appropriate coding to medical bills in compliance with state-specific regulations and industry standards. The ideal candidate will ensure billing accuracy, improve claims efficiency, and reduce compliance risk.
Key Responsibilities
Review incoming medical bills for completeness and accuracy.
Assign proper CPT, ICD-10, and HCPCS codes based on medical records and documentation.
Ensure coding aligns with state regulations, payer-specific rules, and MedRisk policies.
Identify and correct coding discrepancies, unbundled codes, or documentation gaps.
Collaborate with billing, claims, and compliance teams to resolve coding-related issues.
Stay updated with coding changes, fee schedules, and relevant state legislation.
Support audits and internal reviews as needed.
Qualifications
License Requirement: Candidates must have either an LPN or RN license (Temp or FTE).
Experience in medical bill reviewer, preferably in a workers compensation or physical medicine environment.
Strong understanding of state-specific billing guidelines and medical coding compliance.
Proficiency with EHR systems and coding software (e.g., EncoderPro, Availity).
High attention to detail, strong analytical skills, and ability to meet deadlines.
Preferred Skills
Experience working with workers compensation claims.
Familiarity with NCCI edits and payer-specific rules.
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Key updates:
License Requirement: Candidates must have either an LPN or RN license (Temp or FTE).
Strata System Experience: This is no longer required, so please do not use it as a screening factor.
We re actively hiring for both FTE and Temp positions.
Immediate need is for at least 2 FTEs, with the number expected to grow over time.
# of open roles : 3-4
Required Criteria-1 for this role is :
Billing coder and reviewers with experience in Workers compensation
Who has done Bill coding / review / audits from a Payer side. (Insurance company side)
OR - Criteria - 2
Nurse Bill Reviewer or Case Manager - who has done bill reviews and audits from a Payer side.
Well versed with Modifiers
Done billing nationally
Experience with CCI Edits
Anam Chaudhry
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