Bill Review Manager — Remote

Tired of weekends, shift work, and red tape? Ready to join a company where your ideas matter and your expertise drive real change?
At Alius Health, we’re redefining transparency and service in the workers’ compensation pharmacy benefit management (PBM) industry. As a privately-owned, rapidly growing PBM focused exclusively on workers’ compensation, we combine clinical excellence with technology-driven solutions to improve outcomes and lower costs for injured workers.
We’re looking for an experienced medical bill review specialist with a strong background in the workers’ compensation industry. You’ll be in charge of end-to-end pharmacy bill review process, out of network client implementations, and developing out of network strategies. You will be our company expert on out of network bills and will help shape the next generation of Alius Health’s out of network services.
What You'll Do
• Own and manage the end-to-end bill review process, including bill intake, validation, routing, adjudication, exception handling, reconsiderations, and payment-file reconciliation or handoff.
• Design, implement, document, and continuously improve standard operating procedures, workflows, business rules, controls, escalation paths, and training materials.
• Oversee daily production, turnaround times, accuracy, and service-level commitments; resolve complex processing issues.
• Serve as the primary point of contact for bill review technology and service vendors.
• Lead and participate in bill review implementations, system integrations, vendor transitions, process redesign, and other projects.
• Collaborate with IT to define requirements, map data and interfaces, investigate defects, perform user acceptance testing, and validate production changes.
• Collaborate with Operations on client requirements, training, and consistent application of business rules.
• Collaborate with Finance on vendor invoices, bill/payment reconciliations, financial controls, reporting, and discrepancies.
• Coordinate legal or compliance interpretation when needed.
• Oversee provider disputes, duplicate bills, reconsiderations, adjustments, and escalated issues; ensure appropriate documentation and audit trails.
• Develop strategies to increase network penetration.
What You'll Bring
Associate or Bachelor's degree
5+ years of hands-on medical bill review experience in the workers’ compensation industry
Working knowledge of workers’ compensation fee schedules, reimbursement methodologies, billing formats, and multi-state rules
Ability to communicate clearly with executives, vendors, clients, and cross-functional teams; strong judgment, organization, and independent decision-making
Preferred qualifications: Pharmacy bill review experience; familiarity with pharmacy reimbursement and NDC-based pricing; experience launching a bill review program; experience with bill review platforms and integrations; prior people-management experience.
Why Alius Health?
100% remote — flexible work schedule.
Competitive compensation and benefits (PTO, insurance, 401(k), short-term disability, bonus, and more).
Opportunity to directly shape pharmacy bill review strategy and innovation within a nimble, forward-thinking PBM.
Collaborative team environment where your input is valued and your expertise matters.
Pay Range: $75,000-$90,000 per year
If you’re a bill review specialist who wants to make a measurable impact — we’d love to meet you!

Work arrangement
Yes