Clinical and Bill Review Advisor

Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.

About our Opportunity: 

As the Clinical and Bill Review Advisor at Valenz Health, you will play a pivotal role in guiding and advising on our internal clinical and bill review processes. Your expert analysis and insights will be crucial in informing strategic decisions and enhancing operational efficiencies. This role requires a deep understanding of clinical review and bill review practices, enabling you to provide high-level recommendations to leadership based on observed trends, detailed audits, and client engagement. 
 

Things You’ll Do Here: 

• Conduct in-depth analyses of clinical and bill review processes to ensure compliance with industry standards and regulatory requirements. 

• Serve as a key advisor to the leadership team, providing strategic insights and recommendations based on complex reviews and client interactions. 

• Participate in on-site audits as the expert consultant, ensuring thorough and compliant assessments are carried out. 

• Develop and refine guidelines and best practices for clinical and bill review based on the latest industry trends and regulatory updates. 

• Consult on and advocate for workflow enhancements and technological integrations that could significantly improve review accuracy and efficiency. 

• Facilitate knowledge sharing sessions and strategic discussions with stakeholders to ensure alignment and foster informed decision-making. 

• Serve as a mentor or a point of reference for training and development activities within the organization, helping to elevate the knowledge base of all team members involved in clinical and billing reviews. 

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties. 

What You’ll Bring to the Team:   

• Bachelor’s degree in Nursing, Healthcare Administration, or a related field.  

• 5+ years of experience in a clinical setting with a focus on clinical reviews, auditing, or compliance. 

• Current RN license or a similar healthcare certification. 

• In-depth understanding of healthcare regulations, including HIPAA, ICD-10, CPT, HCPCS, and CMS guidelines. Familiarity with state and federal healthcare laws pertaining to billing and insurance practices. 

• Strong analytical and problem-solving skills with the ability to process complex information and present it in a clear, concise manner. 

• Excellent verbal and written communication skills, with demonstrated ability to engage effectively with all levels of staff and leadership within an organization. 

• Experience mentoring and guiding teams in best practices, as well as influencing senior leadership with strategic insights. 

A plus if you have… 

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Clinical Documentation Specialist (CCDS) 
   

Where You’ll Work 

This is a remote role.  
 

Why You Will Love Working Here

We offer employee perks that go beyond standard benefits and compensation packages – see below!

At Valenz, our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You’ll find limitless growth opportunities as we grow together. If you're ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!

Perks and Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting.
• Flexible working environment.
• Generous Paid Time Off to include Vacation, Sick, and Paid Holidays.
• Paid maternity and paternity leave.
• Community giveback opportunities, including paid time off for philanthropic endeavors.

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.

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