Payment Integrity Analyst II

CorVel Corporation•Fort Worth, TX

2d•$66,941 - $101,258•Remote

About The Position

The Payment Integrity Analyst is responsible for accurately reviewing and completing pre- and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position.

Requirements

Must maintain a current LPN, LVN and/or RN licensure
Previous experience in one or more of the following areas required: Medical bill auditing, Experience in the acute clinical areas of facilities in O.R., I.C.U., C.C.U., E.R., Telemetry, Medical/Surgical, OB or L&D, Geriatrics and Orthopedics, Knowledge of worker's compensation claims process, Prospective, concurrent and retrospective utilization review
1+ years healthcare revenue cycle
1+ years of relevant experience or equivalent combination of education and work experience
1+ years hospital bill audit
Ability to use clinical judgment and analytical skills for claim audit review
Knowledge of CMS/commercial payer policies, claims processing and reimbursements, IDC-10 Coding, and DRG Validation
Familiarity with healthcare revenue cycle and coordination of benefits
Proficiency in Microsoft Office, especially using pivot tables in Excel as well as and database tools
Excellent written and verbal communication skills
Strong interpersonal skills across all levels; comfortable interfacing with clients and the C-Suite
Ability to work on several concurrent tasks and prioritize workload to meet designated deadlines
Advanced problem-solving and data analysis capabilities
Proven track record of delivering actionable results
Strong attention to detail

Nice To Haves

Bachelor’s degree in healthcare or related field preferred
Preferred experience with health insurance denials and/or appeals, payer audits, or vendor audits

Responsibilities

Reviews, analyzes, and completes internal audits and/or appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication
Use clinical judgement to appropriately interpret and apply client policies along with CMS guidelines as it relates to reviews done by CERIS such as itemized bill, DRG and/or specialty audits
Utilize applicable tools and resources to complete internal audits and/or appeals
Timely completion of internal audits and/or appeals
Attends clinical team meetings, company meetings, educational opportunities/trainings, and other meetings
Additional duties as assigned