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.

• 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.

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.