Payment Integrity Analyst II

CorVel Career Site•Fort Worth, TX

2d•Remote

About The Position

The Payment Integrity Analyst is responsible for accurately reviewing pre and post pay claim audits based on client, policy, industry standards and/or CMS guidelines. This is a remote position. CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

Requirements

Must maintain a current LPN, LVN and/or RN licensure
1+ years healthcare revenue cycle
1+ years of relevant experience or equivalent combination of education and work experience
1+ years hospital bill audit

Nice To Haves

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

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
Ability to use clinical judgement and analytical skills to appropriately review documentation submitted for claim audits
Utilize 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, All Company Meetings, Education Opportunities, Trainings, and other potential meetings
Additional duties as assigned