Nurse Itemized Bill Reviewer (IBR Analyst)

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. We’re constantly reimagining what’s 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, we’re constantly reimagining what’s possible in our industry—creating 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.

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.