Remote Medical Billing & Claims Audit Specialist – Expert Itemized Bill Review, Coding Compliance & Revenue Assurance

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About the Company – Pioneering the Future of U.S. Healthcare

Our client is a high‑growth, venture‑backed startup on a mission to transform the United States health‑care system. By harnessing cutting‑edge artificial intelligence, advanced analytics, and a culture of relentless innovation, the organization is building a platform that automates medical claim audits, reduces waste, and improves outcomes for patients, providers, and payers alike. The team is composed of visionary technologists, seasoned clinicians, data scientists, and business strategists who thrive on collaboration, curiosity, and a shared commitment to making health care more transparent and affordable.

Working remotely does not mean working in isolation. The company operates with a flat organizational structure that empowers every employee to have direct access to senior leadership, fostering rapid decision‑making, mentorship, and a sense of ownership that is rare in larger enterprises. Whether you are a seasoned professional or a rising star in the billing and coding arena, you will be part of a purpose‑driven environment where your expertise directly influences the next generation of health‑care technology.

Role Overview – What It Means to Be a Medical Itemized Bill Review Specialist

The Remote Medical Billing & Claims Audit Specialist is a critical gatekeeper in the organization’s end‑to‑end claim verification workflow. You will review UB‑04 and Institutional Billing (IB) forms, cross‑reference them against patient medical records, and validate that each billed service aligns with national and payer‑specific coding standards. Your analyses will feed directly into the machine‑learning models that power the platform, ensuring that the technology learns from the most accurate, real‑world data possible.

Beyond the day‑to‑day audit tasks, you will act as a champion for compliance, educating internal stakeholders on coding best practices, identifying systemic patterns of billing errors, and recommending process improvements that drive revenue integrity. In short, you will be the bridge between clinical documentation, regulatory standards, and the financial health of health‑care providers.

Key Responsibilities – Your Daily Impact

• Perform detailed reviews of UB‑04/IB claim forms to detect coding and billing violations, including improper or missing revenue codes, mismatched CPT/HCPCS entries, and inaccurate DRG/APC assignments.
• Audit revenue codes against clinical documentation ensuring that each service recorded in the claim is supported by physician notes, nursing logs, or other appropriate source documents.
• Confirm service delivery by verifying that the procedures, treatments, and supplies billed were actually rendered to the patient, thereby preventing over‑payment or fraudulent claims.
• Document inconsistencies between submitted claims and health‑plan payment outcomes, creating clear, actionable audit reports that highlight root causes and corrective actions.
• Validate automated audit results by applying national coding guidelines (CPT, ICD‑10‑CM, HCPCS, DRG, APC) alongside payer‑specific policies, ensuring that the AI‑driven engine flags only genuine discrepancies.
• Provide ongoing feedback to the product and engineering teams, translating real‑world audit findings into model training data that improves the platform’s accuracy over time.
• Collaborate with cross‑functional teams (product, compliance, operations) to develop best‑practice documentation standards and streamline the claim review workflow.
• Mentor junior auditors by sharing expertise, conducting training sessions, and reviewing their work for accuracy and consistency.
• Stay current with regulatory changes including updates to HIPAA, CMS guidelines, and payer policy revisions, ensuring continuous compliance across all audits.

Essential Qualifications – What You Must Bring

• Minimum three (3) years of experience conducting audits and reviews of medical bills, preferably within a hospital or health‑system environment.
• Proven expertise in facility inpatient coding and a solid grasp of revenue code structures, CPT, ICD‑9/10, HCPCS, DRG, and APC classifications.
• Professional certification – one of the following is mandatory: CPC (Certified Professional Coder), COC (Certified Outpatient Coder), CIC (Certified Incentive Coder), CRC (Certified Revenue Cycle) or CPMA (Certified Professional Medical Auditor).
• In‑depth knowledge of PHI and HIPAA compliance to protect patient confidentiality throughout the audit process.
• Demonstrated ability to interpret clinical documentation and translate it into accurate billing entries, with a focus on detail orientation and analytical rigor.
• Exceptional written and verbal communication skills for clear documentation of audit findings and effective collaboration with remote teammates.
• Proficiency with claim‑review software platforms (e.g., 3M, Optum, Trizetto) and familiarity with Excel or data‑visualization tools to summarize audit results.
• Self‑motivated and disciplined to thrive in a fully remote, results‑oriented setting.

Preferred Qualifications – Additive Assets

• Clinical license such as RN, LPN, or other bedside credential, which provides a deeper understanding of the care delivery process.
• Experience working directly for an insurance carrier or third‑party administrator (TPA), offering insight into payer expectations and claim adjudication workflows.
• Exposure to emerging health‑tech tools, AI‑driven analytics, or data‑science initiatives related to claim processing.
• Familiarity with state‑specific Medicaid/Medicare billing nuances and the ability to adjust audits accordingly.
• Professional memberships in organizations such as AHIMA, AAPC, or HIMSS, indicating commitment to continuing education.

Core Skills & Competencies – The Blueprint for Success

• Analytical Acumen: Ability to dissect complex claim data, spot patterns of non‑compliance, and propose evidence‑based improvements.
• Attention to Detail: Meticulous review of every line item to ensure no billing discrepancy goes unnoticed.
• Critical Thinking: Evaluate ambiguous documentation scenarios and make sound, defensible coding decisions.
• Tech‑Savvy: Comfort navigating modern audit platforms, cloud‑based collaboration tools (Slack, Teams, Confluence), and data‑export utilities.
• Communication Excellence: Translate technical audit findings into clear, concise language for both technical and non‑technical audiences.
• Time Management: Prioritize high‑volume claim queues while meeting strict turnaround targets.
• Adaptability: Thrive in a fast‑changing start‑up environment where processes evolve as the product scales.

Career Growth & Learning – Your Path Forward

Joining this venture‑backed start‑up unlocks a career trajectory rarely found in traditional health‑care organizations. As the platform scales, you will have opportunities to move into senior audit leadership, revenue‑cycle optimization strategy, or product‑focused roles such as Billing Intelligence Analyst or Compliance Program Manager. The company sponsors continuous education, covering certification renewal fees, advanced coding courses, and attendance at industry conferences (e.g., Coding Certification Conference, HIMSS). Moreover, the flat hierarchy means you will receive direct mentorship from founders and senior investors, accelerating professional development and expanding your strategic influence.

Work Environment & Company Culture – What It Feels Like to Be Here

The organization believes that a diverse, inclusive, and purpose‑driven workforce produces the most innovative solutions. Remote team members are integrated through regular virtual town halls, cross‑functional “innovation sprints,” and informal “coffee chat” gatherings that foster a sense of community despite geographic dispersion.

• Flat Structure: No unnecessary layers – your ideas reach decision‑makers quickly.
• Results‑Oriented Flexibility: Work when you’re most productive; the only metric that matters is the quality of your audit work.
• Transparency: Weekly dashboards show company performance, allowing every employee to see how their contributions impact revenue integrity and patient care.
• Recognition Programs: Peer‑nominated awards celebrate audit excellence, innovative process improvements, and mentorship achievements.
• Health‑Focused Benefits: Comprehensive medical, dental, and vision coverage, plus mental‑health resources and wellness stipends.

Compensation, Perks & Benefits – What You’ll Receive

While the specific salary range is competitive and reflective of market standards for senior coding and audit professionals, the total rewards package includes:

• Base Salary: Market‑aligned, performance‑based compensation.
• Performance Bonuses: Quarterly incentives tied to audit accuracy metrics and process‑improvement milestones.
• Equity Participation: Opportunity to own a slice of the company’s future growth through stock options.
• Health Benefits: Full medical, dental, and vision coverage for employees (and optional coverage for dependents).
• Paid Time Off: Flexible vacation policy that encourages work‑life balance.
• Professional Development: Reimbursement for certifications, webinars, and relevant industry conferences.
• Remote‑Work Stipends: Home‑office setup allowance, high‑speed internet reimbursement, and ergonomic equipment budget.
• Wellness Programs: Access to virtual fitness classes, meditation apps, and mental‑health counseling services.

How to Apply – Take the Next Step

If you are a motivated, detail‑oriented professional who thrives in a fast‑moving, technology‑driven environment and is eager to make a tangible impact on the U.S. health‑care ecosystem, we want to hear from you. Please submit your resume, a concise cover letter highlighting relevant experience, and copies of any applicable certifications through the link below. Our recruiting team reviews applications on a rolling basis and will reach out promptly to discuss next steps.

Apply Now – Join the Revolution in Medical Billing Audits

Final Word – Your Future Starts Here

At this innovative start‑up, your expertise will not only safeguard billions of dollars in health‑care spending but also empower providers to focus on delivering high‑quality patient care. By joining as a Remote Medical Billing & Claims Audit Specialist, you become an integral part of a visionary team that is reshaping how the industry thinks about revenue integrity, compliance, and technology. Don’t miss the chance to advance your career while making a lasting, positive impact on the health of the nation.

Apply today and help us build the future of health‑care auditing.

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