Payment Integrity Analyst II
New
J
JobgetherHealthcare Payment Integrity
USFull-TimeMiddle
Salary66,941 - 101,258 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- At least 1 year of relevant professional experience
- Required Skills
- Microsoft Office
Requirements
- Active LPN, LVN, and/or RN license.
- At least 1 year of relevant professional experience.
- At least 1 year of experience in healthcare revenue cycle.
- At least 1 year of hospital bill auditing experience.
- Strong knowledge of claims processing, ICD-10 coding, DRG validation, and coordination of benefits.
- Working knowledge of CMS requirements and commercial payer policies.
- Experience in medical bill auditing or clinical environments (e.g., OR, ICU, ER, Telemetry, Med/Surg, OB, Geriatrics, Orthopedics).
- Proficiency with Microsoft Office, including Pivot Tables and database management.
- Strong analytical, data interpretation, modeling, and complex problem-solving abilities.
- Excellent written and verbal communication skills.
- Ability to manage multiple projects and work within committed timelines.
Responsibilities
- Review, analyze, and complete pre- and post-payment claim audits and appeals in accordance with client policies, CMS guidelines, and healthcare industry standards.
- Apply clinical judgment to evaluate documentation and determine the appropriateness and accuracy of claims.
- Interpret and apply payer policies and regulatory requirements across areas such as itemized bills, DRG reviews, and specialty audits.
- Use relevant systems, tools, and resources to conduct thorough and timely audits, appeals, and payment integrity reviews.
- Analyze healthcare claims, reimbursement information, and supporting documentation to identify discrepancies and potential payment issues.
- Communicate audit findings and conclusions clearly and professionally in both written and verbal formats.
- Manage multiple projects and priorities while meeting established deadlines and quality expectations.
- Collaborate effectively with internal stakeholders and interact professionally with clients and senior-level audiences.
- Contribute analytical insights and actionable recommendations that support strategic payment integrity initiatives.
View Full Description & ApplyYou'll be redirected to the employer's site
