Making healthcare benefits less complex and more accessible, empowering employees to live their healthiest lives.
Physician Advisor – Managed Care Claims & Billing
Location
United States
Posted
71 days ago
Salary
$130 - $150 / hour
Seniority
Senior
Job Description
Physician Advisor – Managed Care Claims & Billing
Healthee
• Support re-pricing and pre-payment processes to ensure accurate claim valuation, validation, and alignment with payer rules and clinical standards. • Review, evaluate, and investigate claims data, medical billing logic, and CPT coding to ensure billing accurately reflects the patient’s care. • Identify and correct mismatches between clinical documentation and billing submissions to prevent denials, errors, compliance risks, and potential fraud or abuse. • Ensure all codes accurately represent the services provided, avoiding both under- and over-billing. • Fraud, Waste, and Abuse Detection (FWA): Identify and investigate potential FWA claims • Conduct detailed reviews of itemized bills, medical records, and other claims data to validate coding accuracy and appropriateness of charges • Work with insurance companies and TPAs to clarify medical necessity, address coverage discrepancies, and resolve claim disputes. • Serve as a subject-matter expert on clinical and billing topics during audits, product reviews, and client implementations. • Collaborate with Growth and Data Science teams to design and build scalable tools and solutions that support new growth opportunities in these areas.
Job Requirements
- MD/DO
- Experience with re-pricing and pre-payment review processes, including claim validation, reimbursement methodologies, and alignment with payer policies.
- Proven experience in claims auditing or payment integrity within a health plan or TPA
- Deep claims expertise with an understanding of provider billing and payer operations.billing, revenue cycle management, and payment integrity
- Solid understanding of CPT, ICD-10, HCPCS codes, and reimbursement processes.
- Strong analytical and communication skills; ability to translate medical concepts into structured business logic.
- Experience in health-tech and data analytics environments, strong plus.
Benefits
- Compensation**:***$130-$150 per hour.* Compensation finally awarded to the candidate will be commensurate with the candidate’s skills and experience. *
Related Guides
Related Categories
Related Job Pages
More General Jobs
Registered Dietitian – Full Time
9amHealthSpecialized care that’s actually there—every step of the way
• Provide comprehensive diabetes, hypertension, hyperlipidemia and weight loss care, education, and support for patients through chat, phone, and video calls following internal protocols • Create thorough consults aligned with internal protocols for 9amHealth physicians • Collaborate with Patient Care Advocates to ensure patient success
Renewal and Expansion Specialist – LATAM
WhippyThe all-in-one SMS, email & voice platform, elevating business productivity with automation and AI-driven technology.
• Run commercial calls with existing customers including renewals, upgrades, downgrades, expansions, and billing conversations • Do contract math live on customer calls • Draft and send contracts for existing customers • Own Stripe-related billing issues for existing accounts • Partner with CSMs on account health signals • Plant seeds for cross-sell and new products during renewal calls • Maintain accurate records of contract terms, renewal dates, and commercial commitments
Senior Service Center Representative
Banner HealthBanner Health is a nonprofit healthcare system based in Phoenix, Arizona. As one of the largest employers in the country, Banner Health utilizes the expertise a
• Take inbound calls answering member and provider questions regarding coverage, benefits, claims, and other plan inquiries • Work in a fast-paced and multitasking environment • Provide excellent customer service and satisfaction with a goal of first call resolution • Research and solve problems for escalated calls • Maintain records, track cases, and log events for assigned area of benefits services • Provide direction and leadership in daily work and workflow of a service center team • Work on special projects as assigned
Licensed Clinical Social Worker, LCSW/LCMHC
Healthstar | Mental and Behavioral Health SupportCulturally sensitive Mental and Behavioral Health Support for Refugee and Immigrant Communities.
• Conduct comprehensive assessments and develop personalized treatment plans for clients. • Provide individual and group therapy sessions to address mental health issues. • Collaborate with multidisciplinary teams to ensure holistic care for clients. • Maintain accurate and timely documentation of client progress and treatment outcomes. • Utilize evidence-based practices to deliver effective therapeutic interventions. • Engage in ongoing professional development and training to enhance clinical skills. • Advocate for clients' needs and connect them with community resources. • Participate in case reviews and contribute to program development initiatives.




