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Bill Review Analyst Jobs (NOW HIRING)

Valenz

Bill Review Operations Coordinator

Phoenix, AZ · Remote

As a Bill Review Operations Coordinator, you will coordinate operational communications, client ... Demonstrated ability to analyze operational data and communicate findings effectively. * Strong ...

Corvel

Bill Review Supervisor I

Pittsburgh, PA · On-site

$22.17 - $35.66/hr

The Bill Review Supervisor is responsible for the supervision of all operations within their ... Effective quantitative and analytical skills * Strong leadership, management, and motivational ...

The AF Group

Medical Bill Rev Specialist I/II

Lansing, MI

$19 - $24.25/hr

SUMMARY Medical Bill Review Specialist I Primarily responsible for analyzing bills for multi-state Workers Compensation medical claims to determine appropriateness of services billed. Responsible for ...

Emergent Holdings

Medical Bill Rev Specialist I/II

Lansing, MI · On-site

$19 - $24.25/hr

SUMMARY Medical Bill Review Specialist I Primarily responsible for analyzing bills for multi-state Workers Compensation medical claims to determine appropriateness of services billed. Responsible for ...

Corvel

Bill Review Supervisor I

Pittsburgh, PA · Hybrid

$22.17 - $35.66/hr

The Bill Review Supervisor is responsible for the supervision of all operations within their ... Effective quantitative and analytical skills * Strong leadership, management, and motivational ...

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How much do bill review analyst jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for bill review analyst in the United States is $30.38, according to ZipRecruiter salary data. Most workers in this role earn between $20.43 and $36.06 per hour, depending on experience, location, and employer.

What is a bill review analyst?

A Bill Review Analyst is a professional who examines and evaluates bills, typically in the healthcare, insurance, or legal industries, to ensure that charges are accurate, compliant with relevant guidelines, and free from errors or overcharges. They review submitted invoices for services rendered, apply appropriate coding and fee schedules, and may negotiate adjustments or denials as necessary. Their work helps organizations control costs, prevent fraud, and maintain compliance with regulations. Bill Review Analysts often use specialized software and must have a strong understanding of billing practices and policies.

What are the key skills and qualifications needed to thrive as a bill review analyst?

To thrive as a Bill Review Analyst, you need strong analytical skills, attention to detail, and a solid understanding of medical billing and insurance claims, typically supported by a degree in healthcare administration or a related field. Familiarity with claims management software, medical coding systems (such as ICD-10 and CPT), and regulatory compliance tools is essential. Effective communication, problem-solving abilities, and time management are key soft skills that help in resolving discrepancies and collaborating with providers. These competencies are vital to ensure accurate claim processing, cost containment, and compliance with industry standards.

What are some common challenges faced by bill review analysts, and how can they be addressed?

Bill Review Analysts often encounter challenges such as interpreting complex billing codes, ensuring compliance with industry regulations, and managing tight deadlines. Staying up-to-date with the latest billing guidelines and software tools can help address these hurdles. Collaborating closely with medical providers, insurers, and internal teams is also key to resolving discrepancies and ensuring accuracy. Developing strong analytical and communication skills can significantly enhance effectiveness in this role.

What is the difference between Bill Review Analyst vs Claims Adjuster?

AspectBill Review AnalystClaims Adjuster
CredentialsCertification in claims or billing, sometimes licensedLicensing required, insurance adjuster certification often needed
Work EnvironmentReviewing medical bills, working in office or remoteInvestigating claims, field or office work
Industry UsageInsurance, healthcare billingInsurance, property and casualty claims

Both roles involve insurance processes but differ in focus: Bill Review Analysts primarily verify medical bills for accuracy and compliance, while Claims Adjusters evaluate overall insurance claims, including damages and liability. Understanding these distinctions helps job seekers target the right position based on their skills and interests.

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Bill Review Analyst jobs near you
Infographic showing various Bill Review Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $63,187 per year, or $30.4 per hour.

Senior Claims Analyst - Hospital Bill Review

SmartLight Analytics

Plano, TX • On-site

$105K/yr

Full-time

Re-posted yesterday

Job description

We are seeking an experienced Senior Claims Analyst with deep expertise in hospital claims adjudication, stop loss reporting, high-cost/catastrophic claims, and DRG (Diagnosis-Related Group) reimbursement methodology. This individual will analyze itemized hospital bills and claims data to identify billing errors, coding discrepancies, DRG misassignments, and other overpayment opportunities, then work directly with claims administrators on behalf of our ASO clients to secure claim adjustments, recoveries, and repricing.
This is a highly analytical, client-facing role requiring both technical claims expertise and strong negotiation/communication skills.
Key Responsibilities
Claims Analysis & Review
  • Perform detailed audits of hospital and facility claims, including itemized bills, UB-04 claim forms, medical records, and remittance advices, to validate billing accuracy.
  • Analyze DRG assignments and coding to identify DRG upcoding, unbundling, duplicate billing, and other irregularities that affect reimbursement.
  • Review high-cost and catastrophic claims (typically $100K+) to identify overpayments, contract misapplication, and opportunities for negotiated adjustments.
  • Evaluate claims against plan documents, provider contracts, reference-based pricing methodologies, and CMS guidelines to determine appropriate reimbursement.
Stop Loss & High-Cost Claims Expertise
  • Understand and apply stop loss (specific and aggregate) provisions, laser terms, and reporting requirements as they relate to claim adjustments and client financial exposure.
  • Coordinate with stop loss carriers and reinsurers as needed to ensure adjustments and recoveries are properly reflected in stop loss reimbursement calculations.
  • Identify claims nearing or exceeding specific deductible thresholds and prioritize review accordingly.
Client Advocacy & Claims Administrator Negotiation
  • Serve as the subject matter expert and advocate on behalf of ASO clients in disputes with claims administrators (TPAs) and carriers regarding claim payment accuracy.
  • Prepare clear, well-documented findings packages (clinical, contractual, and coding rationale) to support requested claim adjustments and appeals.
  • Lead or support negotiations with claims administrators to reach adjusted payment resolutions.
  • Track disputes through resolution, escalating unresolved cases appropriately and maintaining strong working relationships with TPA claims and provider relations teams.
Data & Reporting
  • Analyze large claims data sets to identify trends, outlier claims, and systemic overpayment patterns across client populations.
  • Build and maintain claim tracking logs, savings reports, and client-facing summaries of identified and recovered savings.
  • Partner with internal data/analytics teams to refine claim-flagging logic and improve identification of high-value review opportunities.
Required Qualifications
  • 5+ years of experience in hospital claims analysis, medical bill review, claims auditing, or payment integrity, with direct exposure to self-funded/ASO plans.
  • Strong working knowledge of DRG methodology (MS-DRG/APR-DRG), UB-04 billing, ICD-10-CM/PCS, CPT/HCPCS coding, and hospital chargemaster structures.
  • Demonstrated understanding of stop loss insurance, including specific/aggregate deductibles, laser provisions, and how claim adjustments impact stop loss reimbursement.
  • Experience analyzing high-cost/catastrophic claims and identifying overpayment or billing error patterns.
  • Prior experience interacting with or negotiating against TPAs, insurance carriers, or claims administrators on disputed claims.
  • Proficiency with claims data analysis tools (Excel required; SQL, Access, or claims analytics platforms a plus)
  • Excellent written and verbal communication skills, with the ability to build persuasive, well-supported adjustment requests and appeals.
  • Strong attention to detail and ability to manage a high volume of complex claims simultaneously.
Preferred Qualifications
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Medical Bill Review Specialist, or similar credential.
  • Prior experience at a TPA, insurance carrier, hospital billing/coding department, or payment integrity/cost containment vendor.
  • Familiarity with reference-based pricing (RBP), Medicare fee schedules, and out-of-network claims repricing.
  • Nursing background (RN) or clinical coding background is a plus for clinical validation of DRG and medical necessity issues.
What Success Looks Like
  • Consistent identification of material overpayments and billing errors on high-cost hospital claims.
  • Strong track record of securing favorable claim adjustments through negotiation with claims administrators.
  • Clear, professional communication that strengthens client trust and TPA relationships.
  • Measurable contribution to client savings and stop loss cost containment.

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