Claims Payment Integrity Analyst

CareNational Healthcare Services • Orange, CA

412d • $62,000 - $87,000

About The Position

The Claims Payment Integrity Analyst will oversee various payment methodologies and billing guidelines, ensuring compliance with legislative, regulatory, and contractual requirements related to payment integrity systems and claim adjudication. This remote position requires collaboration with multiple departments to identify and resolve issues effectively, driving operational excellence within the organization.

Requirements

• Bachelor's in Health Administration or 3+ years of experience in Managed Care and Claims Operations in IPA setting; or equivalent combination of education and experience required.
• 3+ years of experience as a medical claims analyst, adjuster, or senior examiner.
• Extensive knowledge of claims processing guidelines, including perspective payment systems, DRG payment systems, comprehensive coding edits, Medicare guidelines, and Medi-Cal guidelines.

Nice To Haves

• CPC license is preferred.
• Master's Degree in Healthcare Administration or equivalent is preferred.
• Microsoft Power BI, SQL, Athena, and IDX System experience is preferred.
• 2+ years of supervisory experience in the healthcare industry is preferred.

Responsibilities

• Oversight of multiple payment methodologies and billing guidelines including CMS, Medicare Provider Reimbursement Manual, NCCI, MUE, LDCs, NCDs, National Uniform Billing Committee, AMA, DRG, APG, APDRG, NDC, etc.
• Ensure adherence to all Legislative, Regulatory, and Contractual requirements as it relates to Payment Integrity systems and claim adjudication.
• Build and maintain productive & collaborative intradepartmental relationships with department leads to enable effective and timely problem/improvement identification & resolution.
• Drive operational excellence within the organization.

What This Job Offers

• Job Type: Full-time
• Industry: Administrative and Support Services
• Education Level: Bachelor's degree