Med Bill Examiner, III

Review, audit, and adjudicate complex medical bills for accuracy, medical necessity, and compliance. Analyze CPT, HCPCS, ICD codes and supporting documentation to identify discrepancies. Apply state-specific guidelines, provider contracts, and internal policies for reimbursement. Document billing determinations clearly and thoroughly for audit readiness. Communicate billing outcomes and requests for additional documentation to partners. Resolve billing disputes and escalated issues using sound judgment. Requirements Advanced experience in medical bill review, claims adjudication, or medical billing audit. Strong working knowledge of medical coding (CPT, HCPCS, ICD), fee schedules, and billing regulations. Certified Professional Coder (CPC). Demonstrated analytical, investigative, and critical-thinking skills. High attention to detail with strong documentation discipline. Ability to manage workload independently while meeting accuracy and turnaround expectations. Effective written and verbal communication skills. Comfort handling complex or disputed billing scenarios. Core Competencies Demonstrates advanced expertise in medical bill review and claims adjudication, with a strong focus on medical coding, compliance, and documentation accuracy. Proficient in analyzing complex billing scenarios and communicating effectively with stakeholders. #J-18808-Ljbffr Jobtailor