Job Description

Overview

We are seeking a detail-oriented and experienced Medical Bill Review Quality Auditor to join our team. This role is critical in ensuring the accuracy, compliance, and quality of our medical bill review processes. The ideal candidate will have a strong background in Managed Care, extensive knowledge of medical bill review, and experience as a medical bill review coder. This individual will play a key role in maintaining high-quality standards, identifying process improvements, and delivering exceptional service to our clients.

• Rolling Meadows, Illinois
• Claims
• 41654
• $94,000 - $183,500
• Fully Remote Worker

Responsibilities

• Proactive Audits: Conduct regular audits of processed medical bills to ensure fee set-ups, exception processes, and other configurations are functioning as intended.
• Identify discrepancies, errors, or inefficiencies and recommend corrective actions.

Client-Specific Audits

• Perform detailed audits tailored to specific client requirements to ensure compliance with contractual obligations and client expectations.
• Collaborate with account teams to address client-specific concerns and provide actionable insights.

Vendor Invoices Auditing

• Review and audit vendor invoices to ensure accuracy, compliance with agreements, and proper billing practices.
• Identify and resolve discrepancies in vendor billing.

Reporting And Scorecards

• Develop and deliver client-specific reports and scorecards, providing clear insights into performance metrics, audit findings, and recommendations.
• Ensure timely and accurate reporting to meet client and internal deadlines.

Quality Assurance

• Monitor and evaluate the overall quality of the medical bill review process, identifying areas for improvement.
• Collaborate with internal teams to implement process enhancements and maintain high-quality standards.

Additional Responsibilities

• Support various tasks associated with ensuring the medical bill review option operates efficiently and effectively.
• Stay updated on industry trends, regulatory changes, and best practices in medical bill review and Managed Care.

Required

• Typically requires a University Degree or equivalent experience and minimum 7 years of prior relevant experience.
• Extensive experience with Workers Compensation bill review and network access processes.
• Prior vendor management and project management experience.
• Strong oral and written communication skills.
• Ability to support transformational planning and the development of business cases.

Preferred

• Minimum of 3-5 years of experience in Managed Care, with a strong focus on medical bill review and auditing.
• In-depth knowledge of medical bill review processes, coding standards (e.g., CPT, ICD-10, HCPCS), and fee schedules.
• Certified Professional Coder (CPC) or equivalent certification preferred.
• Strong attention to detail with the ability to identify patterns, discrepancies, and areas for improvement.
• Excellent written and verbal communication skills to effectively interact with clients, vendors, and internal teams.
• Proactive approach to identifying and resolving issues, with a focus on continuous improvement.
• Proficiency in medical billing software, auditing tools, and Microsoft Office Suite (Excel, Word, PowerPoint).

Work Traits

• Strong organizational skills and ability to manage multiple tasks simultaneously.
• Experience in client-facing roles with a focus on delivering high-quality service.
• Familiarity with regulatory requirements and compliance standards in medical billing.

Compensation And Benefits

We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.

Minimum Core Benefits

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance
• 401(K) and Roth options
• Tax-advantaged accounts (HSA, FSA)
• Educational expense reimbursement
• Paid parental leave

Other Benefits Include

• Digital mental health services (Talkspace)
• Flexible work hours (availability varies by office and job function)
• Training programs
• Gallagher Thrive program elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
• Charitable matching gift program
• And more...

We value inclusion and diversity

Inclusion and diversity (I&D) is a core part of our business, and its embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected by applicable federal, state, or local laws. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Quality Assurance

Industries

• Legal Services

Job Tags

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