Nurse Itemized Bill Reviewer (IBR Analyst)

Who We Are

Machinify 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 60 health plans including many of the top 20 and representing more than 160 million lives Machinify brings together a fully configurable and content-rich AI-powered platform along with best-in-class expertise. Were constantly reimagining whats possible in our industry creating disruptively simple powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Location: This role is full remote

About the Opportunity

At Machinify were constantly reimagining whats possible in our industrycreating 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 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 youll 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 Success Looks Like

After 3 months

• You will have a strong understanding of the role.
• You begin building relationships and collaborating with peers.
• You develop effective time and priorities management.
• You receive initial feedback about your performance and are using it to improve.
• Youve gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

• You have mastered the tasks and responsibilities of the position executing them with confidence and efficiency.
• You have established a strong network of internal relationships and are recognized as a key collaborator.
• Youve been entrusted with greater responsibility indicating the companys confidence in your abilities.
• You see opportunities for career progression and personal development.

Pay range: $75000-$90000 USD

This is an exempt position. The salary range is for Base will be determined based on several factors including but not limited to skill set years of experience and the employees geographic location.

Whats in it for you

• PTO Paid Holidays and Volunteer Days
• Eligibility for health vision and dental coverage 401(k) plan participation with company match and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance short-term disability and parental leave.
• Remote and hybrid work options

What values well share with you

• Ask why
• Think big
• Be humble
• Optimize for customer impact
• Deliver results

At Machinify were reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity teamwork accuracy and flexibility. We do the right thing and we listen to the needs of our clients and their members. As tenured experts with unmatched experience we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally abandoning silos to bring innovative and accurate solutions to market. We invest in each other through ongoing education and team celebrations and we give back to our communities through dedicating days for volunteering. Together Machinify is making healthcare work better for everyone and were passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race color ancestry religion sex national origin sexual orientation age citizenship marital status disability gender gender identity or expression or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable accordance with applicable state laws we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process please contact our People Operations team at . See our Candidate Privacy Notice at: Experience:

Senior IC