Clinical Bill Review Analyst

About Vālenz Health

Vālenz Health® offers an innovative healthcare platform designed to reduce costs, enhance quality, and improve the overall healthcare experience for employers, payers, providers, and members. Leveraging a culture of creativity and a comprehensive suite of integrated solutions, Vālenz engages throughout the patient journey—spanning care navigation, payment integrity, plan performance, and provider verification—with a 99% client retention rate demonstrating their consistent excellence and transparency.

Role Overview

In the role of Clinical Bill Review Analyst, you will conduct detailed reviews of medical claims to detect errors such as improper billing, unbundled charges, and deviations from standard coding guidelines. Your analysis will identify potential savings that support client objectives, complemented by clear communication of findings to internal stakeholders and leadership. This position demands strong analytical skills, effective communication, meticulous attention to detail, and robust organizational capabilities.

Key Responsibilities

• Examine medical bills to validate correct billing, accurate coding, and cost-saving opportunities.
• Investigate and resolve complex claim discrepancies exceeding initial review scope.
• Collaborate closely with the Negotiation team to handle intricate claim issues and maximize savings.
• Prepare detailed Bill Review Reports and assist clients with intricate billing inquiries.
• Address bill reconsideration requests requiring additional research and thorough analysis.
• Manage escalated provider questions, resolve disputes, and conduct direct negotiations for billing discrepancies.
• Mentor junior analysts on best practices in claims review.
• Identify billing trend issues, suggest system and process improvements, and contribute to policy formulation.
• Educate internal teams and clients on updates to billing codes, edits, and review protocols as part of training initiatives.
• Work collaboratively across departments to streamline processes enhancing savings and client satisfaction.
• Ensure strict compliance with HIPAA and relevant regulatory requirements.
• Perform additional duties as required.

Qualifications and Experience

• Minimum three years’ experience in auditing, claims review, or billing within healthcare organizations.
• Certifications such as CPC (Certified Professional Coder) or CIC (Certified Inpatient Coder).
• Proficient knowledge of medical coding systems, including ICD-10, CPT, HCPCS, and Revenue codes.
• Excellent oral and written communication skills.
• Familiarity with CMS guidelines.

Preferred Qualifications

• Experience conducting DRG validation.
• Understanding of Health Insurance, Medicare regulations, and various healthcare programs.
• Exposure to software such as RevCycle Pro, Encoder Pro, and SuperCoder.

Work Setup and Requirements

• This is a fully remote position; all necessary equipment will be provided.
• A quiet, distraction-free workspace is necessary for effective performance.
• A reliable internet connection is essential; typical streaming service bandwidth suffices.
• Strict adherence to company security protocols, including VPN use, secure passwords, and utilizing approved devices and software.
• Applicants must be based in the United States and comply with HIPAA and company policies.

Company Culture and Benefits

Recognized by Inc. 5000 as one of America's fastest-growing private companies, Vālenz fosters an engaged, resilient, and innovative culture dedicated to delivering smarter and faster healthcare solutions. Employees enjoy a comprehensive benefits package designed to support health, financial security, and work-life balance.

• Comprehensive company-subsidized Medical, Dental, and Vision insurance, including services via proprietary products Healthcare Blue Book and KISx Card.
• Availability of Health Savings Accounts (HSA), Flexible Spending Accounts (FSA), and Dependent Care Flexible Spending Accounts (DCFSA).
• 401(k) plan featuring company matching and immediate vesting.
• Flexible working conditions.
• Generous Paid Time Off encompassing vacation, sick days, and holidays.
• Employee Assistance Program offering professional counseling and referral services.
• Paid maternity and paternity leave.
• Pet insurance options.
• Discounts on phone plans, car rentals, and electronics.
• Opportunities for community engagement with paid time off for philanthropic involvement.

Equal Employment Opportunity

Valenz Health is an equal opportunity employer committed to fostering an inclusive and discrimination-free workplace. Employment decisions are based solely on job-related factors and individual qualifications, without regard to any legally protected characteristics.