Alaffia Health
Clinical Itemized Bill Reviewer (RN, CPC)
US +1 · Full-time · Posted Apr 23, 2026
- Location
- US
Remote (United States) - Experience
- Minimum of 3 years of auditing/bill review experience.
- Visa sponsorship
- Requires current authorization to work in the United States; work visa sponsorship is not available.
About the job
Reviews high-dollar facility medical bills and claims against clinical records and audit results to identify billing or coding issues and help train automated claim-audit systems.
What you'll do
- Review UB-04/itemized bills against medical records to validate charges, revenue codes, and services rendered.
- Confirm automated audit results using national and payer-specific guidelines, and document billing or payment inconsistencies.
- Analyze claims, records, and audit outcomes to inform engineering teams and improve automated audits.
What they ask for
- Facility inpatient coding or auditing experience.
- Current RN clinical license.
- At least one certification: CPC, CIC, CRC, or CPMA; alternatively, willingness to obtain one within one year.
- Knowledge of medical billing/coding, claim audits, and relevant coding guidelines and code sets.
Nice to have
- Experience working at an insurance company.
- Experience auditing line-item charges on itemized bills.
Tools
UB-04/IB, CPT codes, ICD-9/10, HCPCS codes, POS codes, DRGs, APCs
AI focus
Reviews automatic audit results and medical claims to help train automated audit systems.
Model-written summary · the original posting is authoritative